title: Pediatric liver transplantation in 31 consecutive children.
abstract: BACKGROUND
  Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.
  
  
  METHODS
  Thirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.
  
  
  RESULTS
  Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.
  
  
  CONCLUSIONS
  The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.
authors.affiliation: Liver Transplantation Institute, General Hospital of Chinese People's Armed Police Force, Beijing 100039, China.
authors.forename: Zhong-yang
authors.initials: ZY
authors.lastname: Shen
authors.forename: Zi-fa
authors.initials: ZF
authors.lastname: Wang
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Zhu
authors.forename: Yun-jin
authors.initials: YJ
authors.lastname: Zang
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
authors.forename: Yong-lin
authors.initials: YL
authors.lastname: Deng
authors.forename: Cheng
authors.initials: C
authors.lastname: Pan
authors.forename: Xin-guo
authors.initials: XG
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate