Outcome of pediatric liver transplant recipients in Turkey: Single center experience

Abstract

To summarize the evolution of the pediatric liver transplant program in a developing country. Between April 1997, and September 2003, 32 cadaveric (CD) and 35 living donor (LD) liver transplantations were performed on 61 children (median age 3.8 yr, range 0.5-16) at Ege University Organ Transplantation and Research Center. The patient's charts were reviewed retrospectively. The outcome of patient and graft survival was analyzed and the incidence of graft loss, complications and rejections was calculated. Indications for liver transplantation were metabolic liver disease (n = 17), biliary atresia (n = 14), viral hepatitis (n = 4), autoimmune hepatitis (n = 6), cryptogenic cirrhosis (n = 11), fulminant liver failure (n = 5) and others (n = 5). Seven of 61 children with chronic liver disease had hepatocellular carcinoma concomitantly. Median pediatric end-stage liver disease score was 23 (range 1-54). Seven children (11.4%) were UNOS status I, 44 (72%) were UNOS status II and 10 (16.6%) were UNOS status III. The median follow-up of the study population was 3.6 yr (range 0.5-6). Actuarial patient survival rates at 1, 2, 3 and 4 yr were 86, 86, 71.3 and 65% in the CD group vs. 80, 76, 67 and 67% in the LR group, respectively (p = NS). Patients listed as UNOS status 1 had lower survival rates than patients listed as UNOS status 2 and 3 (p < 0.05). The mortality rate was 26.2%. Graft survival rates were 81, 81, 75 and 64% at 1, 2, 3 and 4-yr respectively. Six patients (9%) underwent retransplantation. The main complications were infections (64.7%) and surgical complications (43.2%) (including biliary complication, vascular problems, postoperative bleeding, small for size and large for size). The incidence of acute cellular rejection was 39.3%, whereas chronic rejection was 7.4%. The result of liver transplantation in Turkish children was slightly inferior to those reported for North American and European children. However, an important characteristic of these patients that distinguishes them from Europe and North America is that most were UNOS status IIa and UNOS status I (44%). Despite technical and medical progress, infectious and biliary problems have continued to be an important cause of mortality in these patients.

Transplante hepático pediátrico: experiência de 10 anos em um único centro no Brasil

“…3,20 Portal vein thrombosis is rare in adults, but occurs in more than 33% of pediatric liver transplantation recipients, in contrast with what was observed in our study, where there were just two cases. 13 The great majority of biliary complications are secondary to thrombosis of the hepatic artery, 28 and were observed in 7.1% of our cases, which is comparable to what is reported in the literature (5 to 30%). 3 One of our patients had lymphoproliferative disease (2.3%), which is described as affecting 5 to 15% of children after transplantation, 10,22,29,30 The principal causes of immediate repeat transplants are primary non-function of the graft and thrombosis of the hepatic artery, 3,8,13,18,22 while, over the long term, chronic rejection is the number one indication.…”

“…6,10-12 In common with what is reported by the majority of pediatric transplant centers, with the exception of Turkey where the primary cause is metabolic diseases, biliary atresia was the most common indication in this sample. 8,[13][14][15][16][17] The fact that the second most common diagnosis among the group of transplant recipients was fulminating hepatitis is related to the priority that these patients are given, receiving donor organs that would probably go to adult recipients, and other studies have also listed this as their second most common indication. 14,16,17 For the subset of patients transplanted due to chronic liver disease, the five-year survival rate is within the range of results obtained by leading transplant centers, where survival rates can reach 90% during the first year and 64.3 to 83.3% after 5 years.…”

“…19,27 Thrombosis of the hepatic artery is a severe vascular complication that results in loss of the graft and an indication of immediate repeat transplantation. 3,13,14,17,18 It is more common in the pediatric age group (7 to 8%), to a great extent because of technical difficulties, such as the disproportionate diameters of donor and recipient blood vessels, with greater risk of stenosis and thrombosis at the anastomoses. 3 The rate of hepatic artery thrombosis in this patient sample was 16.6%, which is above what is described in the literature.…”

“…14,16,17 For the subset of patients transplanted due to chronic liver disease, the five-year survival rate is within the range of results obtained by leading transplant centers, where survival rates can reach 90% during the first year and 64.3 to 83.3% after 5 years. 8,13,[18][19][20][21][22] Primary non-function and thrombosis of the hepatic artery were the principal causes of death of patients transplanted for chronic liver disease, which is a result that differs from other pediatric transplant centers, where infections tend to be the principal cause of death. 3,8,14,18,22,23 This difference can be attributed to the increased frequency of hepatic artery thrombosis found in this sample.…”

Pediatric liver transplantation: 10 years of experience at a single center in Brazil

“…Assim como relatado na maioria dos centros de transplante pediátrico, à exceção da Turquia, onde as principais causas são doenças metabólicas, a atresia de vias biliares foi a indicação mais freqüente nesta casuística 8,[13][14][15][16][17] . O fato de o segundo diagnóstico mais freqüente no grupo transplantado ser a hepatite fulminante está relacionado à prioridade que estes pacientes alcançam, conseguindo doações que provavelmente iriam para receptores adultos, sendo também a segunda indicação em outros estudos 14,16,17 .…”