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

Abstract

Pediatric liver transplantation (PLT) has very good results at experienced transplant centers. However, there is still an ongoing discussion about inferior outcomes, especially in young infants. The aim of this retrospective study was to evaluate outcomes of infants compared to older recipients in a single center over 20 years. We conducted a retrospective study of children who received liver transplants at our center between 1991 and 2011. Only patients without other limiting organ involvement were included and compared according to age. The inclusion criteria were fulfilled by 351 patients (173 vs. 178). The most common indication in both groups was biliary atresia (82.1% vs. 49.4%). The 1-, 5-, and 10-year patient survivals were 93.8%/91.8%/91.1% and 93%/90.8%/90.1%, and the graft survivals were 90.4%/83.5%/79.6% and 89.4%/81.8%/77.5%, respectively. Complications such as postoperative bleeding, biliary complications, or perfusion impairment occurred more often in infants. Leading indications for retransplantation (vascular complications/primary nonfunction) and leading causes of death (sepsis/multiorgan failure) were the same in both groups. Significant predictors for patient loss were decade of transplantation, retransplantation, postoperative bleeding, and infections for infants. Predictors for graft loss were bowel perforation, arterial thrombosis, and age >12 months. Children can have excellent results, independent of age at PLT.

Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

“…11 23 Infants are at greatest risk to die while waiting for a suitable organ, with deaths on the waiting list being significantly higher in children under 1 year of age. 7 Additionally, this age group is more likely to suffer from perioperative complications than older children when undergoing LT. 11 24 In pediatric patients listed for acute-on-chronic liver failure (ACLF), the waiting list mortality within 90 days is greater (46.6%) than for other types of failure (< 30%), which is especially concerning to children with BA as they represent a substantial part of patients listed for ACLF (45%). 25 Age and body weight as well as nutrition status have been identified as important factors influencing the outcome of LT in children, 26 stressing the potential of KPE to improve the conditions for LT in BA patients by allowing children to gain weight and recuperate.…”

Liver Transplantation Is Highly Effective in Children With Irresectable Hepatoblastoma

“…23 . In general, outcomes after LT in pediatric patients are superior to adults, independent of donor or indication for transplantation, reaching 1-year survival rates of up to 95% 34 . Adults undergoing LT for malignant tumors, have unsatisfactory outcomes, in part due to tumor recurrence.…”

Liver Transplantation Is Highly Effective in Children with Irresectable Hepatoblastoma

“…SIOPEL-1 and the World Experience Review showed superior survival rates of 85% at 10 years and 82% at 10 years after primary transplantation [ 22 , 23 ]. Zsiros et al showed in the SIOPEL-3 and-4 studies that transplantation was associated with a 75% 3-year survival rate [ 33 , 34 ].…”