Current Status and Outcomes of Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Results From a Multicenter Retrospective Study Over Two Decades

Author:

Uchida Hajime1ORCID,Hong Suk Kyun2ORCID,Okumura Shinya3,Cherukuru Ramkiran4ORCID,Sanada Yukihiro5ORCID,Yamada Yohei6,Reddy Mettu Srinivas7ORCID,Matsuura Toshiharu8,Hara Takanobu9,Chen Chao‐Long10,Yi Nam‐Joon2ORCID,Ikegami Toru11,Kasahara Mureo1ORCID,

Affiliation:

1. Organ Transplantation Center National Center for Child Health and Development Tokyo Japan

2. Department of Surgery Seoul National University College of Medicine Seoul Korea

3. Department of Surgery, Graduate School of Medicine Kyoto University Kyoto Japan

4. Institute of Liver Disease and Transplantation Dr Rela Institute and Medical Centre Chennai India

5. Division of Gastroenterological, General and Transplant Surgery, Department of Surgery Jichi Medical University Shimotsuke Japan

6. Department of Pediatric Surgery Keio University School of Medicine Tokyo Japan

7. Institute of Liver Disease and Transplantation Gleneagles Global Health City Chennai India

8. Department of Pediatric Surgery, Graduate School of Medical Sciences Kyushu University Fukuoka Japan

9. Department of Surgery Nagasaki University Graduate School of Medical Sciences Nagasaki Japan

10. Department of Surgery, Liver Transplantation Center Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan

11. Department of Surgery The Jikei University School of Medicine Tokyo Japan

Abstract

ABSTRACTBackgroundAlthough the outcomes of living donor liver transplantation (LDLT) for pediatric acute liver failure (PALF) have improved, patient survival remains lower than in patients with chronic liver disease. We investigated whether the poor outcomes of LDLT for PALF persisted in the contemporary transplant era.MethodsWe analyzed 193 patients who underwent LDLT between December 2000 and December 2020. The outcomes of patients managed in 2000–2010 (era 1) and 2011–2020 (era 2) were compared.ResultsThe median age at the time of LDLT was 1.2 years both eras. An unknown etiology was the major cause in both groups. Patients in era 1 were more likely to have surgical complications, including hepatic artery and biliary complications (p = 0.001 and p = 0.013, respectively). The era had no impact on the infection rate after LDLT (cytomegalovirus, Epstein–Barr virus, and sepsis). The mortality rates of patients and grafts in era one were significantly higher (p = 0.03 and p = 0.047, respectively). The 1‐ and 5‐year survival rates were 76.4% and 70.9%, respectively, in era 1, while they were 88.3% and 81.9% in era 2 (p = 0.042). Rejection was the most common cause of graft loss in both groups. In the multivariate analysis, sepsis during the 30 days after LDLT was independently associated with graft loss (p = 0.002).ConclusionsThe survival of patients with PALF has improved in the contemporary transplant era. The early detection and proper management of rejection in patients, while being cautious of sepsis, should be recommended to improve outcomes further.

Funder

Ministry of Health, Labour and Welfare

Publisher

Wiley

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