Long-Term Pediatric Live-Donor Liver Transplantation Survivors: Patient and Allograft Outcomes.
1Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
2Thomas E. Starzl Transplantation Institute, Pittsburgh, PA
3Division of Pediatric Gastroenterology, Pittsburgh, PA
Meeting: 2017 American Transplant Congress
Abstract number: B274
Keywords: Graft function, Graft survival, Liver transplantation, Pediatric
Session Information
Session Name: Poster Session B: Pediatric Liver Transplant - Clinical
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Aim: To determine the patient and allograft outcomes at 5 years after pediatric live-donor liver transplantation (LDLT).
Methods: Children with a minimum of 5-year survival post-transplantation were reviewed in terms of patient-allograft histologic characteristics, post-operative complications and immunological management. Allograft biopsies were evaluated according to presence of inflammation and fibrosis status.
Results: Between 1997 and 2016, 109 children underwent LDLT. Overall patient and graft survivals are 92% and 89% respectively. We further analyzed 48 patients with a minimum of 5-year survival. Main indications were biliary atresia (23), acute hepatic necrosis (10), metabolic diseases (2), malignant neoplasms (4) and other cholestatic diseases (9). Median recipient age was 0.7 years (range 0.03-19.08 years). The allograft types were left lateral segment (43), left lobe (3) and right lobe (2). The post-operative surgical complications were: intra-abdominal bleeding (9), portal vein thrombosis (PVT, 4), biliary leak (4), and biliary stricture (11). Biopsy-proven acute cellular rejection (ACR) was documented in 31 patients within the first 6 months after transplantation. PTLD was present in 3 patients but was not associated with graft loss or mortality. Immunosuppressive monotherapy and immunosuppressive-free patients were achieved in 72.9% and 6.2% rates respectively. Graft and extra-hepatic outcomes for patients with 5-year or more survival and their allograft biopsy results are shown in Table-1.
| Patient number | |
| ACR | 31(64.6%) |
| HAT | 0 |
| PVT | 4(8.3%) |
| Biliary leak | 4(8.3%) |
| Orphan duct | 2(4.2%) |
| Biliary stricture | 11(22.9%) |
| PTLD | 3(6.2%) |
| Presence of inflammation (allograft biopsy) | 25(52.1%) |
| Fibrosis status (allograft biopsy) | |
| none-minimal | 17(35.4) |
| mild | 22(45.8%) |
| moderate | 7(14.6%) |
| severe | 2(4.2%) |
Conclusions: LDLT is a life-saving procedure with an excellent survival rate and outcomes for children with manageable morbidities. LDLT may also allow for less immunosuppression requirements over the long term. Low incidence of fibrosis compared to historical data requires ongoing investigation.
CITATION INFORMATION: Celik N, Ganoza A, Bond G, Soltys K, Sindhi R, McKiernan P, Humar A, Mazariegos G. Long-Term Pediatric Live-Donor Liver Transplantation Survivors: Patient and Allograft Outcomes. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Celik N, Ganoza A, Bond G, Soltys K, Sindhi R, McKiernan P, Humar A, Mazariegos G. Long-Term Pediatric Live-Donor Liver Transplantation Survivors: Patient and Allograft Outcomes. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-pediatric-live-donor-liver-transplantation-survivors-patient-and-allograft-outcomes/. Accessed November 24, 2024.« Back to 2017 American Transplant Congress