title: Pediatric liver transplantation for acute liver failure at a single center: a 10-yr experience.
abstract: Children transplanted for ALF urgently require an optimal graft and have lower post-transplant survival compared with children transplanted for chronic liver disease. Over 10 yr, 33 consecutive children transplanted for ALF were followed. Demographics, encephalopathy, intubation, dialysis, laboratory values, graft type ABOI, XL (GRWR > 5%), DDSLT, LDLT and WLT were evaluated. Complications and survival were determined. ALF accounted for 33/201 (16.4%) of transplants during this period. Twelve of 33 received ABOI, five XL grafts, 18 DDSLT, and three LDLT. Waiting time pretransplant was 2.1 days. One- and three-yr patient survival in the ALF group was 93.4% and 88.9%, and graft survivals were 86.4% and 77.7%. Median follow-up was 1452 days. ABOI one- and three yr patient and graft survival in the ALF was 91.6% and 78.6%. No difference in graft or patient survival was noted in the ALF and chronic liver disease group or the ABOI and the ABO compatible group. A combination of ABO incompatible donor livers, XL grafts, DDSLT, LDLT and WLT led to a short wait time and subsequent graft and patient survival comparable to patients with non-acute disease.
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA 30322, USA. thomas.heffron@choa.org
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Heffron
authors.forename: Todd
authors.initials: T
authors.lastname: Pillen
authors.forename: Gregory
authors.initials: G
authors.lastname: Smallwood
authors.forename: John
authors.initials: J
authors.lastname: Rodriguez
authors.forename: Sundari
authors.initials: S
authors.lastname: Sekar
authors.forename: Stuart
authors.initials: S
authors.lastname: Henry
authors.forename: Miriam
authors.initials: M
authors.lastname: Vos
authors.forename: Katherine
authors.initials: K
authors.lastname: Casper
authors.forename: Nitika Arora
authors.initials: NA
authors.lastname: Gupta
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Fasola
authors.forename: Rene
authors.initials: R
authors.lastname: Romero
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D016019:Survival Analysis; D014019:Tissue Donors / Q000600:supply & distribution