Short- and long-term results of liver transplantation in infants aged less than 6 months.
BACKGROUND
Despite major surgical and medical advances, it is still a challenge to perform transplantation in small infants. This study, focusing on short- and long-term outcomes, summarizes our 10-year experience with liver transplantation (LTx) in infants aged less than 6 months.


METHODS
We analyzed 43 patients aged 6 months or less (range: 12-184 days, median: 136 days) whose median weight at the time of LTx was 5.8 kg (range: 2.8-8.0 kg). The reasons for LTx were biliary atresia (n=27; 62.8%), neonatal hepatitis (n=6; 14%), neonatal cholestasis (n=4; 9.3%), and miscellaneous (n=6; 14%). The patients were followed up for a median time of 3 years and evaluated with respect to graft function, physical, and neurodevelopmental outcome.


RESULTS
The patient survival was 90.7% after 1 year and 87.2% after 2 years. The graft survival was 86% after 1 year and 82.1% after 2 years. Twelve patients (27.9%) experienced 15 surgical complications requiring intervention, two of whom demonstrated vascular thrombosis (4.7%). Acute early rejection occurred in 15 patients (34.9%), and chronic rejection occurred in 3 patients (7%); 83.3% of the patients had normal liver function test results at the time of evaluation. Complications such as posttransplant lymphoproliferative disease (4.7%) and persistent arterial hypertension (4.7%) were rarely seen. The physical and neurodevelopmental outcomes were good.


CONCLUSIONS
LTx in infants aged less than 6 months provides excellent short- and long-term results. Low weight or young age of infants awaiting LTx should not be exclusion criteria for LTx.
Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany. e.grabhorn@uke-uni-hamburg.de
Enke
E
Grabhorn
Andrea
A
Schulz
Knuth
K
Helmke
Bernd
B
Hinrichs
Xavier
X
Rogiers
Dieter C
DC
Broering
Martin
M
Burdelski
Rainer
R
Ganschow
D001835:Body Weight; D016572:Cyclosporine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008775:Methylprednisolone