Liver transplantation in children less than 1 year of age

Sokal, Étienne; Veyckemans, Francis; Goyet, Jean de Ville de; Moulin, D.; Hoorebeeck, N. Van; Alberti, Daniele; Buts, Jean-Paul; Rahier, Jacques; Obbergh, Luc Van; Clapuyt, P.; Carlier, Marianne; Claus, D.; Latinne, Dominique; Hemptinne, Bernard de; Otté, Jean-Bernard

doi:10.1016/s0022-3476(05)80531-1

Cited by 99 publications

(51 citation statements)

References 16 publications

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“…Previous experience has in older recipients, and graft failure from shown that acute rejection may evolve into chronic rejection did not occur. The published chronic rejection.6 20 This pattern was observed literature has not previously suggested that in our patients, in that acute rejection had been allograft rejection is less common after liver, dnocumeintedA in e-achl of the-n1 allorafts in 10 28 Our finding was therefore an unexpected one. If age at transplantation is truly a significant risk factor for rejection, this would be of great biological interest and an important clinical observation.…”

Section: Resultssupporting

confidence: 58%

“…The numbers of subjects in these groups were 28, 28, and 45 respectively, and the percentages developing acute rejection were 29, 57, and 60. The median numbers of days to rejection in these subject groups were 12 (95% confidence interval (CI) 7 to 35), 10 (95% CI 7 to 14), and 8 (95% CI 7 to 9). The reduced risk for acute rejection in the younger patients is confirmed by the statistical significance of the difference in survival curves (p<0.03).…”

Section: Resultsmentioning

confidence: 98%

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Risk factors for liver rejection: evidence to suggest enhanced allograft tolerance in infancy.

Murphy

Harrison

Davies

et al. 1996

Archives of Disease in Childhood

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After liver transplantation, a relatively low intensity immunosuppressive regimen is employed in our unit: after initial triple therapy (prednisolone, azathioprine, cyclosporin), prednisolone is discontinued at three months and azathioprine at one year. A retrospective study was therefore performed to determine the incidence of rejection, and to identify risk factors for rejection in our patient population.Over a 10 year period, 135 transplants were performed on 109 children. Thirty four (25%) were on infants less than 1 year old. Incidences of acute rejection and irreversible chronic rejection were calculated for grafts surviving more than one and four weeks respectively. Acute rejection occurred in 51 of 101 allografts (50%), and irreversible chronic rejection in 11 of 91 allografts (12%). The immunosuppression strategy was not associated with an increased incidence of rejection.Acute Despite these advances, there is still considerable post-transplant morbidity, and retransplantation is often necessary.' 2 Rejection is common and remains an important cause of allograft failure.2 6 Immunosuppression is associated with a high incidence of complications, infection being the most frequent cause of death after transplantation.78 We have employed an immunosuppressive regimen which is less intense than those utilised in other centres.' 26 9 12 The aims of this study were therefore to determine the impact of rejection on our patient population, and to identify potential risk factors for rejection. Patients and methods PATIENTSA retrospective study was carried out in June 1993 on the 109 children who had undergone liver transplantation between 1983 and 1993 in the paediatric liver transplant programme in Birmingham. The case records were reviewed, and the histological results were reassessed in cases in which rejection had been reported, in order to systematically grade severity.Of the 109 children transplanted, 24 required a second transplant, and two a third, so that in total 135 transplants were performed. The recipients ranged in age from 8 weeks to 15 years (median 2.5 years). Reduced size grafts were employed in 74 (55%) of the procedures, and 34 (25%) of the transplants were in subjects less than 1 year old. There were 51 male and 58 female recipients. All donor/recipient matches were ABO blood group compatible. The median period of posttransplant follow up was 55 weeks (range 0-8

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Section: Resultssupporting

confidence: 58%

Section: Resultsmentioning

confidence: 98%

Risk factors for liver rejection: evidence to suggest enhanced allograft tolerance in infancy.

Murphy

Harrison

Davies

et al. 1996

Archives of Disease in Childhood

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“…14 All our patients showed to variable degrees histological features compatible with the diagnosis of chronic hepatitis C. The histological aspect of chronic hepatitis C was not specific in our experience and this is generally explained by immunosuppression itself, which may alter the histological appearance of viral hepatitis after transplantation.15 In addition associated problems may interfere, such as rejection, cytomegalovirus related hepatitis, ischaemic injury, drug toxicity, and vascular and biliary problems.15 16 Although none of the patients had fibrosis nor cirrhosis, a longer follow up is needed to establish long term prognosis of this slowly progressive disease, whose natural history in paediatric patients who have not been transplanted also remains poorly documented. It has been shown that only 10% of children infected with hepatitis C virus but not transplanted achieve sustained biochemical remission and that severe active hepatitis or even cirrhosis may develop within six years of infection.17 No case of acute graft failure or rapidly progressive hepatitis was observed in our series, in agreement with other paediatric and adult series.7 18 Development of cirrhosis is described in adult patients, and 50% of adult patients may have chronic active hepatitis two years after the initial acute hepatitis C virus hepatitis.…”

Section: Discussionmentioning

confidence: 77%

“…In patients with abnormal liver histology or biochemical tests, additional serum samples were tested for antihepatitis C virus by third generation recombinant immunoblot assay (RIBA3.0) and for hepatitis C virus RNA by polymerase chain reaction (PCR) (see laboratory techniques). In seven out of 16 children, a well preserved frozen biopsy sample obtained at the time of the liver enzyme abnormalities was available for hepatitis C virus RNA and hepatitis C virus antigen detection, using a new immunohistochemical assay, as described elsewhere.8 Liver tissue hepatitis C virus RNA was also detected by the PCR technique.…”

Section: Patientsmentioning

confidence: 99%

Role of hepatitis C virus in chronic liver disease occurring after orthotopic liver transplantation.

Pastore

Willems

Cornù

et al. 1995

Archives of Disease in Childhood

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“…In subgenus C, types 1, 2, and 5 cause respiratory, hepatic, and gastrointestinal illness in children with SCID (8,42,111,112,137). In subgenus F, adenovirus (Table 5) (12,42,67,68,82,85,98,102,110,122,138). Infection of the transplanted liver, particularly by adenovirus types 1, 2, and 5, is evidenced by clinical signs of jaundice, hepatomegaly, and hepatitis (42,67,68,85,122).…”

Section: Adenoviruses In Primary Immunodeficienciesmentioning

confidence: 99%

Adenoviruses in the immunocompromised host

1992

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Adenoviruses are among the many pathogens and opportunistic agents that cause serious infection in the congenitally immunocompromised, in patients undergoing immunosuppressive treatment for organ and tissue transplants and for cancers, and in human immunodeficiency virus-infected patients. Adenovirus infections in these patients tend to become disseminated and severe, and the serotypes involved are clustered according to the age of the patient and the nature of the immunosuppression. Over 300 adenovirus infections in immunocompromised patients, with an overall case fatality rate of 48%, are reviewed in this paper. Children with severe combined immunodeficiency syndrome and other primary immunodeficiencies are exposed to the serotypes of subgroups B and C that commonly infect young children, and thus their infections are due to types 1 to 7 and 31 of subgenus A. Children with bone marrow and liver transplants often have lung and liver adenovirus infections that are due to an expanded set of subgenus A, B, C, and E serotypes. Adults with kidney transplants have viruses of subgenus B, mostly types 11, 34, and 35, which cause cystitis. This review indicates that 11% of transplant recipients become infected with adenoviruses, with case fatality rates from 60% for bone marrow transplant patients to 18% for renal transplant patients. Patients with AIDS become infected with a diversity of serotypes of all subgenera because their adult age and life-style expose them to many adenoviruses, possibly resulting in antigenically intermediate strains that are not found elsewhere. Interestingly, isolates from the urine of AIDS patients are generally of subgenus B and comprise types 11, 21, 34, 35, and intermediate strains of these types, whereas isolates from stool are of subgenus D and comprise many rare, new, and intermediate strains that are untypeable for practical purposes. It has been estimated that adenoviruses cause active infection in 12% of AIDS patients and that 45% of these infections terminate in death within 2 months. In all immunocompromised patients, generalized illness involving the central nervous system, respiratory system, hepatitis, and gastroenteritis usually have a fulminant course and result in death. Treatments for adenovirus infections are of little proven value, although certain purine and pyrimidine analogs have shown beneficial effects in vitro and may be promising drugs.

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Liver transplantation in children less than 1 year of age

Cited by 99 publications

References 16 publications

Risk factors for liver rejection: evidence to suggest enhanced allograft tolerance in infancy.

Risk factors for liver rejection: evidence to suggest enhanced allograft tolerance in infancy.

Role of hepatitis C virus in chronic liver disease occurring after orthotopic liver transplantation.

Adenoviruses in the immunocompromised host

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