Results of pediatric liver transplantation in an originally adult liver transplant program.
BACKGROUND
It is controversial whether pediatric liver transplantation (OLT) should only be performed in a high-volume pediatric or in mixed adult/pediatric centers. We reviewed pediatric OLT results in an originally adult OLT center.


RESULTS
Our adult OLT program was initiated in 1989, currently transplanting approximately 55 livers/year. A pediatric OLT program was launched in 1999. Pre- and posttransplant follow-up is multidisciplinary. In the study period, 26 OLT were performed in 25 patients (6% of all OLT; n = 430). The mean age was 8 years (range: 1 month to 18 years). Mean weight was 22 kg (4 to 80 kg). The indications were: acute liver failure in one (4%); chronic liver failure in 25 (96%)-10 metabolic, six biliary atresia, five polycystic/liver fibrosis, four other, and one retransplant. Nine (35%) received partial graft; 5 (19%) multivisceral grafts (liver-kidney, liver-bowel) and 12 (46%), conventional OLT. In all small-weight children, microsurgery was used. Immunosuppression included calcineurin inhibitors (cyclosporine/tacrolimus), azathioprine/mycophenolate mofetil, low-dose steroid, and anti-interleukin-2 receptor in 14. Early hepatic artery thrombosis (HAT), portal vein thrombosis, and primary nonfunction were not encountered. One retransplantation (4%) was done at 4 years posttransplantation for late HAT. Three biliary complications (11%) were encountered at 2 weeks, 4 months, and 2 years. Percentage of early acute and chronic rejections were 7.7% and 0%. Three deaths occurred due to mycotic aneurysm at 2 weeks; Cytomegalovirus at 4 months; pulmonary infection at 2 years. Twenty-two of 25 patients (88%) are well at last follow-up (up to 8 years).


CONCLUSIONS
Despite representing a small percentage of overall OLT activity pediatric OLT were performed with excellent results in a center with sufficient OLT volume and ad hoc surgical, pediatric, and intensive care team expertise.
Pirenne
J
J
Abdominal Transplant Surgery Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Jacques.Pirenne@uz.kuleuven.ac.be
Aerts
R
R
Monbaliu
D
D
Coosemans
W
W
Vlasselaers
D
D
Desmet
L
L
Herman
J
J
Hoffman
I
I
Lombaerts
R
R
D000328:Adult; D002648:Child; D005705:Gallbladder Diseases / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D017741:Survivors; D013927:Thrombosis / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology; D014850:Waiting Lists