title: Pediatric liver transplantation: fourteen years of experience at the children institute in São Paulo, Brazil.
abstract: This study reports the 14-year experience of a single center on 206 liver transplantations from living and cadaveric donors performed in 179 pediatric patients. Biliary atresia (57.2%) and fulminant hepatitis (9.8%) were the most frequent indications. The mean age of the recipients was 3 years, 7 months (9 months to 18 years) and mean weight was 14 kg (7 to 57 kg). The allografts were distributed as 82 (39.8%) whole cadaveric, 76 (36.9%) reduced-size cadaveric, 46 (22.3%) living donor liver transplants, and 2 (0.9%) ex situ split livers. The waiting periods were 25 days for living donors and 2.5 years for cadaveric donors (P <.001). Twenty-seven children were retransplanted with hepatic artery thrombosis the most frequent indication. The postoperative complications were: primary nonfunction (12.2%), biliary stenosis (28.8%), hepatic artery thrombosis (12.2%), portal vein stenosis (4.9%), hepatic vein stenosis (6.9%), and lymphoproliferative disorder (5.9%). The diagnosis of biliary stenosis was obtained by liver biopsy and transhepatic cholangiography and treated by balloon dilatation, although four children (3.9%) required a redo hepaticojejunostomy. The venous stenoses were percutaneously dilated with five-children (4.9%) requiring venous stents. The incidence of hepatic vein stenosis was 15.6% among living donor and 2.5% in cadaveric liver transplantation (P <.05). The overall 5-year patient and graft survivals were 70.2% and 65.1%. Liver transplantation provides excellent long-term survival. The use of grafts from living donors decreases the waiting periods but increases the incidence of hepatic vein stenosis.
authors.affiliation: Liver Transplantation Unit, Children Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: U
authors.initials: U
authors.lastname: Tannuri
authors.forename: M C P
authors.initials: MC
authors.lastname: Velhote
authors.forename: M M
authors.initials: MM
authors.lastname: Santos
authors.forename: N E
authors.initials: NE
authors.lastname: Gibelli
authors.forename: A A
authors.initials: AA
authors.lastname: Ayoub
authors.forename: J G
authors.initials: JG
authors.lastname: Maksoud-Filho
authors.forename: M M
authors.initials: MM
authors.lastname: Silva
authors.forename: M L
authors.initials: ML
authors.lastname: Pinho
authors.forename: H T
authors.initials: HT
authors.lastname: Miyatani
authors.forename: J G
authors.initials: JG
authors.lastname: Maksoud
mesh_terms: D001938:Brazil; D002102:Cadaver; D002648:Child; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D016896:Treatment Outcome