title: Liver transplantation in children younger than 1 year--the Cincinnati experience.
abstract: OBJECTIVE
  The success of pediatric orthotopic liver transplantation (OLTxp) has improved greatly since its widespread application in the 1980s. No group has benefited more from this than infants younger than 1 year. The authors reviewed their experience in the management and outcome of children who underwent OLTxp when they were younger than 1 year.
  
  
  METHODS
  A retrospective review of the medical records of patients who at the time of OLTxp were younger than 1 year was performed. Patients were stratified according to the period when transplanted.
  
  
  RESULTS
  Eighty-one infants younger than 1 year underwent OLTxp. End-stage liver disease secondary to biliary atresia was the most common indication for transplantation. The overall survival was 77%. One-year patient and graft survival improved from 58% and 50% in the period 1986-1989, respectively, to 88% and 81% in the period 2000-2003, respectively. Technical complications such as hepatic artery thrombosis (n = 5) and portal vein thrombosis (n = 8) occurred, and although 4 patients required retransplantation, all but one survived. Complications associated with immunosuppression, sepsis/multisystem organ failure (MSOF) (n = 11), and posttransplant lymphoproliferative disease (PTLD) (n = 1) were the most common cause of poor outcome.
  
  
  CONCLUSIONS
  Successful OLTxp in infants is possible with improved posttransplant survival during the study period. Technical complications (hepatic artery thrombosis/portal vein thrombosis) may require retransplantation but were uncommon causes of patient loss. Multisystem organ failure was the most significant adverse complication. The consequences of immunosuppression (MSOF/PTLD) were the most common cause of patient loss. Further improvement in overall survival will require better immunosuppressive strategies.
authors.affiliation: Pediatric Liver Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. greg.tiao@cchmc.org
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Tiao
authors.forename: Maria
authors.initials: M
authors.lastname: Alonso
authors.forename: Jorge
authors.initials: J
authors.lastname: Bezerra
authors.forename: Nada
authors.initials: N
authors.lastname: Yazigi
authors.forename: James
authors.initials: J
authors.lastname: Heubi
authors.forename: William
authors.initials: W
authors.lastname: Balistreri
authors.forename: John
authors.initials: J
authors.lastname: Bucuvalas
authors.forename: Frederick
authors.initials: F
authors.lastname: Ryckman
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000150:complications; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000209:etiology; D009102:Multiple Organ Failure / Q000209:etiology; D009820:Ohio; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents