Successful liver transplantation in babies under 1 year.

Beath, S. V.; Brook, Gail; Kelly, Déirdre; Cash, A. J.; McMaster, P; Mayer, A. D.; Buckels, J. A. C.

doi:10.1136/bmj.307.6908.825

Cited by 82 publications

(51 citation statements)

References 17 publications

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“…18,19 Immunosuppression consisted of triple therapy with cyclosporine, prednisolone (2 mg/kg/d), and azathioprine (2 mg/kg/d). 20 Target cyclosporine levels were initially at 250 ng/mL, decreasing to 150 ng/mL by 1 year after OLT. Prednisolone was gradually reduced and stopped 3 months after transplantation.…”

Section: Methodsmentioning

confidence: 99%

Outcome of liver retransplantation in children

et al. 1999

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Irreversible liver graft failure is a life-threatening complication. We reviewed the first 200 pediatric liver transplantations in Birmingham. Forty-one children developed primary graft failure, 9 of whom developed secondary graft failure. The main indications for graft failure were primary nonfunction (PRNF; 8 patients), vascular complications (VASC; 23 patients), and chronic rejection (CHRE; 19 patients). Thirty-two children underwent retransplantation (ReTx) (21 children received reduced grafts; 11 children, whole hepatic grafts). Patient survival was significantly worse for retransplant recipients compared with children receiving a single graft (63% v 76.5% actuarial patient survival at 1 year; P F .05). Primary graft 1-year actuarial survival was 74% in first grafts compared with 47% for regrafts (P F .05), but improved with time. The graft 1-year survival rate was 55% for whole grafts and 45% for reduced and/or split grafts in the first 100 grafts compared with 83% and 66% in the second 100 grafts, respectively (P F .01). Emergency ReTx within a month of transplantation was associated with more complications and a worse outcome (1-year survival rate, 37%) compared with patients who underwent ReTx later (1-year survival rate, 72%; P F .01). The incidence of primary graft failure decreased from 33% in the first 100 grafts to 16% in the second 100 grafts (P F .01), as did the incidence of PRNF, which decreased from 8% to 0% (P F .05). Although the rates of graft failure from VASC decreased from 15% to 8% (P ‫؍‬ .2) and CHRE decreased from 11% to 8% (P ‫؍‬ .6), neither reached statistical significance. The improved results overall are because of advances in surgical techniques, intensive care management, and graft preservation and refinements in immunosuppression. We conclude that ReTx for a child with primary graft failure is justified.

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Section: Methodsmentioning

confidence: 99%

Outcome of liver retransplantation in children

et al. 1999

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“…D 2005 Elsevier Inc. All rights reserved. Liver transplantation has developed over time in children of all age groups, and it has been shown that results in infants are satisfactory [1][2][3][4][5]. However, the need for transplantation in infancy implies that the liver disease is rapidly progressing.…”

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confidence: 98%

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confidence: 99%

“…As a result, infants who are candidates for transplantation are usually in a poor clinical state with a combination of malnutrition and complications related to an end-stage liver disease. The association of young age and very low weight makes transplantation a challenging intervention, and higher morbidity rates have been reported [1][2][3]6].Younger patients are therefore at risk for higher rates of diaphragmatic complication after pediatric liver transplantation [7-9], but diaphragmatic hernia has not been reported as a unique occurrence.In this report, the authors outline 2 cases of diaphragmatic hernia that are complicating liver transplantation and discuss the possible contributing factors. …”

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Right-sided diaphragmatic hernia in infants after liver transplantation

McCabe

Orr

Sharif

et al. 2005

Journal of Pediatric Surgery

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“…10,11 Many neonatal liver diseases begin in utero, resulting in low birth weights. Normal body mass accrual is poor despite aggressive enteral or parenteral hyperalimentation.…”

Section: Recipient Statusmentioning

confidence: 99%

Liver transplantation in neonates

Sundaram

Alonso

Whitington

2003

Liver Transplantation

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Orthotopic liver transplantation (OLT) has evolved over the past two decades to become the standard of care for end-stage liver disease in infants and children. Technical advances, particularly the use of technical variant allografts, have permitted extension of OLT into a much younger and smaller population than previously possible. Major centers around the world now routinely perform OLT in infants with survival success equivalent to that in older children and adults. We are beginning to see a small population of school-aged children who were infant OLT recipients. The further extension of OLT into neonates is more recent, with only a few pediatric centers reporting survival success. Very little is known about this frontier of transplantation. Our intent is to provide an overview of neonatal OLT using all available data and our experience in the field. (Liver Transpl 2003;9:783-788.)F or the purpose of this review, neonatal orthotopic liver transplantation (OLT) is defined as transplantation performed in the first three months of life. This does not coincide with the usual definition of the neonate, infants in their first month of life. The extension to three months is necessary, however, because of the manner in which data regarding pediatric OLT have been collated. This division also holds because most diseases necessitating neonatal OLT produce liver failure at or near the time of birth. United Network for Organ Sharing (UNOS) data show that in 2001, 623 pediatric OLTs were performed in the United States. Of these transplantations, 167 were performed in children younger than one year of age and only eight in neonates. The number of neonatal OLT procedures has been varied over the past four years from eight to 14, with the peak in 2000. Patient and graft survival, 57% and 38% respectively, remain significantly lower than that of older children. 1,2 UNOS data show that infants three to 12 months old have graft and patient survival of 72.8 % and 82.1%, respectively. Children aged one to five years have 76.8% graft and 84.1% patient survival, and those older than six years have greater than 82% graft and 91% patient survival. These data demonstrate that transplantation in neonates presents unique medical and technical challenges. The complexities of liver transplantation in this age group have received relatively little attention in the medical literature. This review details the common indications for transplantation, addresses the multiple obstacles to successful transplantation, and explores strategies to improve survival and long-term outcomes in neonatal recipients. Defining the ProblemThe age distribution of reported neonatal OLTs is evenly distributed across the first three months of life. Woodle et al reported a series of 23 neonatal OLTs performed at three US centers: 28% were less than one month old, 35% were one to two months old, and 36% were two to three months old at the time of transplantation. 2 The youngest infant reported to undergo liver transplant was five days old. 3 The typical body weight...

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Successful liver transplantation in babies under 1 year.

Abstract: Objective-To review the outcome of liver transplantation in babies aged less than 1 year.Design-Prospective evaluation of survival, clinical complications, and nutritional and developmental status before and one year after liver transplantation.

Cited by 82 publications

References 17 publications

Outcome of liver retransplantation in children

Outcome of liver retransplantation in children

Right-sided diaphragmatic hernia in infants after liver transplantation

Liver transplantation in neonates

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