title: Lessons from the first 100 liver transplantations in children at Bicêtre Hospital.
abstract: The authors report their experience with 100 liver transplantations at Bicêtre Hospital. From 1988 to 1991, 85 children received a total of 100 liver grafts (mean age, 44.4 months; two thirds were under 3 years of age). Fifty-four percent of the grafts were reduced-size. Cyclosporine, steroids, and azathioprine were used for immunosuppression. The actuarial survival rate at 4 years is 86%. Retransplantation was performed in 14 children (16%). Forty-four patients (49%) had another operation. Biliary complications (17%), hepatic artery thrombosis (HAT) (14%), and hemoperitoneum (14%) were the most frequent surgical complications. Retransplantation was avoided in 50% of the patients who underwent urgent artery revision for thrombotic complications. It appeared that ABO-incompatible were better tolerated in children without ABO alloantibodies at the time of transplantation. The survival rates of ABO-identical, -compatible, and -incompatible liver grafts did not differ (61%, 50%, and 57% respectively). The results suggest that an aggressive policy of reintervention, including retransplantation, is necessary to achieve a satisfactory survival rate and quality of life. Children lacking ABO alloantibodies at the time of transplantation might tolerate ABO-incompatible liver grafts better.
authors.affiliation: Department of Pediatric Surgery, Hôpital Bicêtre, Kremlin Bicêtre, France.
authors.forename: T
authors.initials: T
authors.lastname: Yandza
authors.forename: F
authors.initials: F
authors.lastname: Gauthier
authors.forename: J
authors.initials: J
authors.lastname: Valayer
mesh_terms: D000017:ABO Blood-Group System; D000206:Actuarial Analysis; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005602:France / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D015996:Survival Rate
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents