Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.583
Peer-review started: August 1, 2021
First decision: September 29, 2021
Revised: October 31, 2021
Accepted: February 19, 2022
Article in press: February 19, 2022
Published online: March 27, 2022
Processing time: 234 Days and 19.7 Hours
Liver transplantation (LT) has become an acceptable curative method for children with several liver diseases, especially irreversible acute liver failure and chronic liver diseases. King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases.
To report the experience with pediatric LT and evaluate outcomes of living-related vs deceased-donor grafts.
This evaluation included children who underwent LT between August 2004 and November 2019. Data were retrospectively reviewed, including demographics, diagnoses, laboratory values of donors and recipients, the pediatric end-stage liver disease (PELD) or model for end-stage liver disease (MELD) score, graft source, wait time, perioperative course, postoperative complications, and survival rates. Continuous data were reported using the median and interquartile range. The Mann–Whitney U-test was used to compare the wait time between the living-related and deceased-donor groups. The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications. Survival rates were calculated using the Kaplan–Meier method.
Ninety-four operated pediatric liver transplant patients were identified (54% were females). The median age at transplantation was 1.2 (0.8-3.8) years. The median PELD and MELD scores were 20 (13-26.8) and 19.5 (15.8-26.3), respectively. Most grafts (81.9%) were obtained from living-related donors. The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6 (0.3-3.1) mo vs 11.2 (2.1-33.3) mo (P = 0.01). Most patients were diagnosed with biliary atresia (74.5%), and infection was the most common complication within 30 d post-transplantation (14.9%). Without a desensitization protocol, 9% of transplants were ABO-incompatible. Eight hepatitis B core antibodies (anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications. The overall survival rate was 93.6% and 90.3% at 1 and 5 years, respectively. No graft loss during follow-up was noted among survivors.
A significant number of pediatric LT cases were reported in Thailand. Based on relatively comparable outcomes, ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.
Core Tip: Pediatric liver transplantation (LT) is an acceptable life-saving operation for several chronic liver diseases and irreversible acute liver failure. This single-center data was analyzed from pediatric LTs performed between August 2004 and November 2019. This study evaluated the most extensive series of pediatric liver transplant recipients in Thailand in the past two decades. Preoperative and postoperative data, including complications and survival, were reviewed. The overall 5-year survival rate was > 90%. In addition, the satisfying outcomes of ABO-incompatible living-donor and hepatitis B core antibody-positive graft transplantation were also highlighted.