[Evolution of children one year post liver transplant].
Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.
Cuarterolo
Miriam
M
Hospital de Pediatría Juan P. Garrahan, Buenos Aires. mcuarterolo@intramed.net
Ciocca
Mirta
M
López
Susana
S
Cervio
Guillermo
G
Rojas
Luis
L
Bianco
Gustavo
G
Speranza
Ana
A
Sasbon
Jorge
J
De Davila
María T G
MT
Questa
Horacio
H
Lipsich
Jose
J
Bes
David
D
Fernandez
Cristina
C
Dip
Marcelo
M
Ayarzabal
Victor
V
Tau
Cristina
C
Vaiani
Elisa
E
Del Pino
Mariana
M
Oleastro
Matias
M
Delgado
Norma
N
Delfino
Virginia
V
Bravo
Enrique
E
Norton
Eduviges
E
Imventarza
Oscar
O
D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome