title: Decreased mortality from technical failure improves results in pediatric liver transplantation.
abstract: 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.
  
  
  METHODS
  We retrospectively analyzed 90 pediatric transplant procedures in a university medical center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, University of California, San Francisco, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Kuang
authors.forename: P
authors.initials: P
authors.lastname: Rosenthal
authors.forename: J P
authors.initials: JP
authors.lastname: Roberts
authors.forename: J F
authors.initials: JF
authors.lastname: Renz
authors.forename: P
authors.initials: P
authors.lastname: Stock
authors.forename: N L
authors.initials: NL
authors.lastname: Ascher
authors.forename: J C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D007231:Infant, Newborn; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality* / Q000639:trends; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure