Pediatric Transplantation: The Hamburg Experience

Kim, Jong-Sun; Grotelüschen, Rainer; Mueller, Teresa; Ganschow, Rainer; Bicak, Turan; Wilms, Christian; Müeller, Lars; Helmke, K.; Burdelski, M.; Rogiers, Xavier; Bröering, Dieter C.

doi:10.1097/01.tp.0000160758.13505.d2

Cited by 48 publications

(67 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This protocol differs from the regimens used in some other pediatric transplant programs in two respects: steroid withdrawal was usual and occurred early, and target cyclosporine levels were in the lower range. Despite this, the incidence of acute rejection in our program 34 was similar to [35][36][37] or less than 38,39 that reported by others. Others have reported physical and metabolic benefits from steroid withdrawal, without any increase in acute rejection, 40,41 albeit undertaken at a later stage after transplantation than in our series.…”

Section: Discussionmentioning

confidence: 68%

See 1 more Smart Citation

Progressive histological damage in liver allografts following pediatric liver transplantation

Evans¹,

Kelly²,

McKiernan³

et al. 2006

Hepatology

283

388

View full text Add to dashboard Cite

The long-term histological outcome after pediatric liver transplantation (OLT) is not yet fully understood. De novo autoimmune hepatitis, consisting of histological chronic hepatitis associated with autoantibody formation and allograft dysfunction, is increasingly recognized as an important complication of liver transplantation, particularly in the pediatric population. In this study, 158 asymptomatic children with 5-year graft survival underwent protocol liver biopsies (113, 135, and 64 at 1, 5, and 10 years after OLT, respectively). Histological changes were correlated with clinical, biochemical, and serological findings. All patients received cyclosporine A as primary immunosuppression with withdrawal of corticosteroids at 3 months post OLT. Normal or near-normal histology was reported in 77 of 113 (68%), 61 of 135 (45%), and 20 of 64 (31%) at 1, 5, and 10 years, respectively. The commonest histological abnormality was chronic hepatitis (CH), the incidence of which increased with time [25/113 (22%), 58/135 (43%), and 41/64 (64%) at 1, 5, and 10 years, respectively) (P < .0001)]. The incidence of fibrosis associated with CH increased with time [13/25 (52%), 47/58 (81%), and 37/41 (91%) at 1, 5, and 10 years, respectively) (P < .0001)]. The severity of fibrosis associated with CH also increased with time, such that by 10 years 15% had progressed to cirrhosis. Aspartate aminotransferase (AST) levels were slightly elevated in children with CH (median levels 52 IU/L, 63 IU/L, and 48 IU/L at 1, 5, and 10 years, respectively), but this did not reach statistical significance compared with those with normal histology. On multivariate analysis, the only factor predictive of chronic hepatitis was autoantibody positivity (present in 13% and 10% of children with normal biopsies at 5 and 10 years, respectively, and 72% and 80% of those with CH at 5 and 10 years, respectively) (P < .0001). Four children with CH and autoantibodies, who also had raised immunoglobulin G (IgG) levels and AST greater than 1.5؋ normal fulfilled the diagnostic criteria for de novo autoimmune hepatitis (AIH). Another two were found to be hepatitis C positive. No definite cause for CH could be identified in the other cases. In conclusion, chronic hepatitis is a common finding in children after liver transplantation and is associated with a high risk of developing progressive fibrosis, leading to cirrhosis. Standard liver biochemical tests cannot be relied on either in the diagnosis or in the monitoring of progress of chronic allograft hepatitis. In contrast, the presence of autoantibodies is strongly associated with the presence of CH. The cause of chronic hepatitis in transplanted allografts is uncertain but may be immune mediated, representing a hepatitic form of chronic rejection.

show abstract

Section: Discussionmentioning

confidence: 68%

“…The indications for transplantation, patient and graft survival, re-transplantation rate, incidence of acute rejection, and viral infections and use of innovative surgical approaches are similar in our center to contemporaneous reports. 34,35,37,39,40,42 …”

Section: Discussionmentioning

confidence: 99%

Progressive histological damage in liver allografts following pediatric liver transplantation

Evans¹,

Kelly²,

McKiernan³

et al. 2006

Hepatology

283

388

View full text Add to dashboard Cite

show abstract

“…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 .…”

Section: Introductionunclassified

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

Mesquita

Ferreira

Veloso³

et al. 2008

J Pediatr (Rio J)

View full text Add to dashboard Cite

“…During the last 25 years, survival rates after pediatric liver transplantation (Ltx) have increased steadily, with survival rates currently ranging from 85% to 97% among liver transplanted children (1,2). Today, pediatric Ltx is a wellestablished treatment for a variety of liver diseases in their final stage.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Performance in Pediatric Liver Transplant Recipients

Kaller

Langguth

Petermann

et al. 2013

American Journal of Transplantation

View full text Add to dashboard Cite

To date, the course of cognitive development in children after liver transplantation (Ltx) is poorly understood. Cognitive performance, however, is crucial in all developmental stages and for educational achievement. This cross‐sectional single‐center study examined the prevalence of long‐term cognitive impairment in a cohort of 64 pediatric patients after Ltx. Median age at Ltx was 12 months. The revised Wechsler Intelligence Scale IV was administered to assess cognitive performance. Patients were compared with an age‐ and gender‐matched group of children without a chronic health condition. Liver transplanted children performed significantly worse in three of four cognitive domains as well as in the Total Intelligence Quotient (Total IQ) (p = 0.017 to p = 0.005). Liver transplant recipients showed substantially more “serious delays” (IQ < 70) compared to the reference group (9.4% vs. 4.7%). Children with a genetic–metabolic disease performed worse than the other groups in three of the four WISC Indices and in the Total IQ (p = 0.05 to p = 0.01). The strongest association was revealed between height at Ltx and Verbal Comprehension (R2 = 0.21), Perceptual Reasoning (R2 = 0.30), Working Memory (R2 = 0.23) and Total IQ (R2 = 0.25). Our results indicate a high impact of primary diagnosis and height percentile at Ltx even on children's long‐term cognitive performance.

show abstract

Pediatric Transplantation: The Hamburg Experience

Cited by 48 publications

References 20 publications

Progressive histological damage in liver allografts following pediatric liver transplantation

Progressive histological damage in liver allografts following pediatric liver transplantation

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

Cognitive Performance in Pediatric Liver Transplant Recipients

Contact Info

Product

Resources

About