title: Long-term outcomes of 600 living donor liver transplants for pediatric patients at a single center.
abstract: This report concerns the long-term outcome of living donor liver transplantation (LDLT) for pediatric patients at a single center. Between June 1990 and December 2003, a total of 600 LDLTs, including 568 primary transplantations and 32 retransplantations, were performed for pediatric patients, who were immunosuppressed with FK506 and low-dose corticosteroids. Patient survival at 1, 5, and 10 years were 84.6%, 82.4%, and 77.2%, respectively, and the corresponding findings for graft survivals were 84.1%, 80.9%, and 74.5%. Multivariate analysis demonstrated that fulminant hepatic failure (FHF), a graft vs. body weight (GBWR) ratio of <0.8, and ABO-incompatible transplants were independently associated with both patient and graft survival. The retransplantation rate was 6%, and 55 patients (9.7%) have been completely weaned off immunosuppressants. Long-term patient and graft survival after pediatric LDLT for a large cohort of children at our hospital were found to be as good as those for cadaveric liver transplantation, although this series includes 13% liver transplantations with ABO-incompatible donors, which are obviously inferior in patient and graft survival. To obtain better outcomes for patients with FHF and for patients with ABO-incompatible transplants, immunosuppressive therapy needs to be improved.
authors.affiliation: Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Shogoin, Kyoto, Japan. mikiko@kuhp.kyoto-u.ac.jp
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D016896:Treatment Outcome