Year: 2021
Type: article
Study design: Observational Study
Abstract: Background: Living donor liver transplantation (LDLT) is a significant advancement for the treatment of children with end-stage liver disease given the shortage of deceased donors. The ultimate goal of pediatric LDLT is to achieve complete donor safety and zero mortality of pediatric recipients. Methods: We conducted a retrospective, single center assessment of the outcomes as well as the clinical factors that may influence graft and patient survival after primary LDLTs conducted between 1994 and 2020. A Cox's proportional hazards model was used for multivariate analysis. The trends for independent prognostic factors were analyzed according to the treatment era, i.e. I (1994-2002), II (2003-2011), and III (2012-2020). Results: Primary LDLTs were conducted on 287 children under 17 years of age during the study period. Biliary atresia (52%), acute liver failure (ALF; 26%), and monogenic liver disease (11%) were the leading indications. Overall losses of the graft and patients were 45 (16%) and 27 (7%) during the study period. During era I (n=81), the cumulative survival rates at 1 and 5 years after LDLT were 90.1% and 81.5% for patients, and 86.4% and 77.8% for grafts, respectively. During era II (n=113), the corresponding rates were 92.9% and 92% for patients, and 89.4% and 86.7% for grafts. During era III (n=93), the corresponding rates were 100% and 98.6% for patients, and 98.9% and 95.4% for grafts. During era III, only a patient died of metastatic recurrences of a hepatocellular carcinoma. In multivariate analyses, primary diagnosis ALF, surgical complications, bloodstream infections, post-transplant lymphoproliferative disease, and chronic rejection were negative prognostic indicators for graft or patient survival. Conclusions: Based on generalized care guidelines and center-oriented experiences, comprehensive advances in appropriate donor selection, refinement of surgical techniques, and meticulous medical management may eventually realize a zero mortality rate for pediatric LDLT.
Institutions: Asan Medical Center, University of Ulsan
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3203330516