Establishment of a pediatric liver transplantation program: experience with 100 transplantation procedures.
OBJECTIVE
To analyze the primary factors that influence the development and consolidation of a pediatric liver transplantation program.


METHODS
This was a retrospective study of 100 liver transplantation procedures performed in 84 pediatric patients between May 1990 and November 2007. The male-female ratio was 40:60. Mean (SD) age was 5 years (40 patients were younger than 2 years); cold ischemia time was 7.10 (3.1) hours; surgery time was 5.2 (2.2) hours; and time on the waiting list for transplantation was 75 (range, 1-1012) days. Indications for transplantation included cholestatic disease (43%), acute hepatic failure (AHF; 34%), metabolic disorders (14%), and cirrhosis (9%). Transplanted organs included 3 split grafts, 29 partial grafts, and 8 living-donor grafts.


RESULTS
Mean graft survival was 70.4%, 59.2%, and 58.1% at 1, 3, and 5 years, respectively. Factors that influenced graft outcome were age younger than 2 years; surgery time more than 6 hours; and AHF vs cholestatic disease, metabolic disorders, and cirrhosis. There were no significant differences in long-term (51% vs 59%) and short-term (71% vs 70%) graft survival between procedures performed in 1990-1998 compared with those performed in 1999-2007; however, there was a higher percentage (P = .005) of recipients at high risk (age younger than 2 years or with AHF) in the later period. All data were consistent with those of the European Liver Transplant Registry 2007.


CONCLUSIONS
A pediatric liver transplantation program can be established by a group experienced in liver transplantation.
Ciria
R
R
Unit of Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, Cordoba, Spain. rubenciria@hotmail.com
Sánchez-Hidalgo
J M
JM
Briceño
J
J
Naranjo
A
A
Pleguezuelo
M
M
Díaz-Nieto
R
R
Luque
A
A
Jiménez
J
J
García-Menor
E
E
Gilbert
J J
JJ
de la Mata
M
M
Pérez-Navero
J L
JL
Solórzano
G
G
Rufián
S
S
Pera
C
C
López-Cillero
P
P
D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods; D014850:Waiting Lists