Pediatric transplantation: the Hamburg experience.
BACKGROUND
Since starting our program in 1989, 455 pediatric orthotopic liver transplantations have been performed using all techniques. In April 2001, we experienced our last in-hospital death of a pediatric liver-transplant recipient. Since then, all our liver-transplant children (n=170) were able to be discharged from the hospital. The aim of this study is to analyze the actual status of pediatric liver transplantation at the University of Hamburg and to find future perspectives to improve the results after pediatric liver transplantation.


METHODS
From May 4, 2001 until September 8, 2004, 22 (13%) whole organs, 18 (11%) reduced-size organs, 79 (47%) split organs, and 51 (30%) organs from living donors were transplanted into 142 patients. One hundred forty-one were primary liver transplants, 25 retransplants, 3 third, and 1 fourth liver transplants. Of the 170 orthotopic liver transplantations (OLT), 31 (18%) were highly urgent (United Network of Organ Sharing [UNOS] I).


RESULTS
After 170 consecutive pediatric liver transplants, no patients died during the hospital course (100% patient survival<3 months), but overall, 5 (2.9%) recipients died during further follow-up. The 3-month and actual graft survival rates are 93% and 85%, respectively. Twenty (11.8%) children had to undergo retransplantation. However, patient survival was not sustained by longer graft survival. Analyzing our series, we see that graft survival after reduced-size liver transplantation showed a significantly lower rate versus living-donor liver transplantation.


CONCLUSIONS
The learning curve in pediatric liver transplantation has reached a turning point where immediate patient survival is considered the rule. The challenge is to increase graft survival to the same level. The long-term management of the transplant patients, with the aim of avoiding late graft loss and achieving excellent quality of life, will become the center of the debate.
Kim
Jong-Sun
JS
Department of Surgery, University Hospital Eppendorf, University of Hamburg, Hamburg, Germany.
Grotelüschen
Rainer
R
Mueller
Teresa
T
Ganschow
Rainer
R
Bicak
Turan
T
Wilms
Christian
C
Mueller
Lars
L
Helmke
Knut
K
Burdelski
Martin
M
Rogiers
Xavier
X
Broering
Dieter C
DC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology