Outcomes of Liver Transplantation in Small Infants

Abstract

Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short‐term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6‐118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124‐179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1‐, 5‐, and 10‐year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management.

Short‐ and long‐term results of liver transplantation according to age at transplant: a single‐center experience of 351 children

“…As described before, hepatic artery thrombosis (HAT) still remains one of the main reasons for graft loss among pediatric recipients [2,12,21,23,29,30], especially in small recipients [24]. However, the incidence of HAT has steadily declined with technological advances, reducing the rate to 5–10% in large pediatric liver transplant programs [17,19,25,30–32]. In our study population, vascular complications appeared in 9.8% of the infants versus 5.6% in older children.…”

“…Despite the major advances and the steadily declining average age of PLT recipients [4], there are still relatively few studies focusing on the long-term outcome according to age and particular aspects of timing for PLT [2,[10][11][12][13][14]. Patient referral to transplant centers is often delayed because of young age and suspected worse outcome, although historically they have had the highest rates of wait-list mortality among all pediatric candidates [14][15][16][17]. Complications associated with immunosuppression or surgical procedures such as vascular thrombosis, biliary tract complications, and infections are a concern and reported to have a higher incidence in smaller recipients the smaller anatomy makes the operation more difficult, with the potential for subsequent complications and worse outcomes [2,5,14,17].…”

“…Patient referral to transplant centers is often delayed because of young age and suspected worse outcome, although historically they have had the highest rates of wait-list mortality among all pediatric candidates [14][15][16][17]. Complications associated with immunosuppression or surgical procedures such as vascular thrombosis, biliary tract complications, and infections are a concern and reported to have a higher incidence in smaller recipients the smaller anatomy makes the operation more difficult, with the potential for subsequent complications and worse outcomes [2,5,14,17]. On the other hand, there may be some immunological advantages for very young liver graft recipients due to the immature immune system, resulting in good outcomes for this age group [18].…”

“…Despite the major advances and the steadily declining average age of PLT recipients [4], there are still relatively few studies focusing on the long‐term outcome according to age and particular aspects of timing for PLT [2,10–14]. Patient referral to transplant centers is often delayed because of young age and suspected worse outcome, although historically they have had the highest rates of wait‐list mortality among all pediatric candidates [14–17].…”

Outcome of liver transplantation and prevalence of liver fibrosis in Crigler‐Najjar syndrome

“…Furthermore, in some studies LT in young infants shows lower acute graft rejection rates due to an immature immune system and, therefore, might be beneficial 16,17 . However, these aspects have to be weighed against the disadvantages of an early LT. Accumulation of immunosuppression leading to a higher risk of developing PTLD 18 or other side effects and technically challenging operation procedures in small infants are facts that need to be considered 19 . Ultimately, ideal timing of LT might remain one of the most challenging aspects during treatment of CNS.…”