Decreased mortality from technical failure improves results in pediatric liver transplantation
A. A. Kuang, P. Rosenthal, J. P. Roberts, J. F. Renz, P. Stock, N. L. Ascher and J. C. Emond
Department of Surgery, University of California, San Francisco, USA.
BACKGROUND: Until recently, pediatric liver transplantation was associated
with a high rate of technical failure, which contributed substantially to
the overall prognosis. OBJECTIVE: To assess the impact of technical failure
on outcome in pediatric liver transplantation. DESIGN AND SETTING: We
retrospectively analyzed 90 pediatric transplant procedures in a university
medical center. PATIENTS: Between February 1988 and December 1995, 80
children ( < 15 years old) received 90 transplants. Fifty-three percent
(n = 42) were less than 2 years of age, 45% (n = 36) had cholestatic liver
disease, 26% (n = 21) had metabolic errors, and 11% (n = 9) had fulminant
hepatitis. INTERVENTION: Patients underwent grafting using previously
reported techniques, including cadaveric whole (61% [n = 55]), reduced-size
(17% [n = 15]), and living related (22% [n = 20]) liver transplantation.
MAIN OUTCOME MEASURES: Patient and graft survival and selected surgical
complications. Outcomes were compared before (group 1) and after (group 2)
the introduction of living related transplantation in July 1992. RESULTS:
In group 1, 32 patients received 36 grafts (4 retransplants [13%]), and in
group 2, 48 patients received 54 grafts (6 retransplants [13%]). Six- and
12-month patient survival rates were 78% (n = 25) and 75% (n = 24),
respectively, for group 1 and 98% (n = 47) and 94% (n = 45) for group 2. Of
the 9 deaths in group 1, 6 occurred early as a consequence of surgical
complications, while in group 2, all 5 deaths that occurred were caused by
the consequences of immunosuppression (lymphoproliferative disease, n = 2;
late infections, n = 3). CONCLUSIONS: These results suggest that mortality
caused by surgical complications has been reduced by improvement in
management in recent years. Living related grafts have supplemented the
graft supply and may be associated with the improved overall results.
Despite these advances, children receiving transplants continue to
experience the consequences of imperfect immunosuppression.
