Olivier Boillot1, Olivier Guillaud2, Gabriella Pittau3, Christine Rivet4, Catherine Boucaud5, Alain Lachaux6, Jérôme Dumortier7. 1. Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France. 2. Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France. 3. Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 4. Department of Pediatric Hepatogastroenterology and Nutrition, and Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France. 5. Department of Anesthesiology, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France. 6. University Claude Bernard Lyon 1, Lyon, France; Department of Pediatric Hepatogastroenterology and Nutrition, and Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France. 7. Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Lyon, France. Electronic address: jerome.dumortier@chu-lyon.fr.
Abstract
BACKGROUND: Liver transplantation (LT) is a standard-of-care therapeutic modality for selected patients with life-threatening liver disease, including children. In addition to specific clinical characteristics of pediatric LT recipients due to initial liver disease (and related comorbidities) and level of liver failure, early postoperative outcome may be dependent on the surgical technique used, related to the type of organ donor and graft. Therefore, the aims of the present retrospective study from a large single centre cohort were to identify the prognostic factors for both 1-year patient and graft survival. METHODS: Between October 1990 and October 2010, 151 children underwent a first LT in our centre. RESULTS: The mean age was 5.3 ± 7.4 years, and the main indication was biliary atresia (BA) (49.0%). Living donor liver transplantation (LDLT) was performed in 39 cases (25.8%). Cadaveric liver graft was a whole liver in 50 cases (33.1%) and a partial liver (reduced or split) in 62 cases (41.1%). One-year patient and graft survival rates were 88.7% and 86.1%, respectively. Multivariate analysis disclosed that initial liver disease, location at time of LT, donor/recipient (D/R) delta age, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with patient survival and that D/R delta age, primary non-function, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with graft survival. CONCLUSION: The results of our single-centre experience of pediatric LT emphasize that early patient and graft survivals depend on pre-operative/operative factors such as initial liver disease, D/R delta age and immunosuppressive regimen. Awareness of these factors can help in the decision making for children requiring LT.
BACKGROUND: Liver transplantation (LT) is a standard-of-care therapeutic modality for selected patients with life-threatening liver disease, including children. In addition to specific clinical characteristics of pediatric LT recipients due to initial liver disease (and related comorbidities) and level of liver failure, early postoperative outcome may be dependent on the surgical technique used, related to the type of organ donor and graft. Therefore, the aims of the present retrospective study from a large single centre cohort were to identify the prognostic factors for both 1-year patient and graft survival. METHODS: Between October 1990 and October 2010, 151 children underwent a first LT in our centre. RESULTS: The mean age was 5.3 ± 7.4 years, and the main indication was biliary atresia (BA) (49.0%). Living donor liver transplantation (LDLT) was performed in 39 cases (25.8%). Cadaveric liver graft was a whole liver in 50 cases (33.1%) and a partial liver (reduced or split) in 62 cases (41.1%). One-year patient and graft survival rates were 88.7% and 86.1%, respectively. Multivariate analysis disclosed that initial liver disease, location at time of LT, donor/recipient (D/R) delta age, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with patient survival and that D/R delta age, primary non-function, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with graft survival. CONCLUSION: The results of our single-centre experience of pediatric LT emphasize that early patient and graft survivals depend on pre-operative/operative factors such as initial liver disease, D/R delta age and immunosuppressive regimen. Awareness of these factors can help in the decision making for children requiring LT.
Authors: Emad Hamdy Gad; Ahmed Nabil Sallam; Hosam Soliman; Tarek Ibrahim; Tahany Abdel Hameed Salem; Mohammed Abdel-Hafez Ali; Mohammed Al-Sayed Abd-Same; Islam Ayoub Journal: Ann Med Surg (Lond) Date: 2022-06-07
Authors: Christina Dalzell; Paola A Vargas; Kyle Soltys; Frank Dipaola; George Mazariegos; Jose Oberholzer; Nicolas Goldaracena Journal: Transpl Int Date: 2022-03-22 Impact factor: 3.782