title: Paediatric liver transplantation in Johannesburg: initial 29 cases and prospects for the future.
abstract: BACKGROUND
  The Wits Donald Gordon Medical Centre paediatric liver transplant programme is the second such unit in sub-Saharan Africa. Initiated in November 2005, it forms part of the centre's solid organ transplant unit, comprising kidney, liver and simultaneous kidney-pancreas arms. Initially established in the private sector, we recently received government approval to expand our programme into the provincial sector and have performed transplants on several provincial-sector patients. Current challenges relate to the lack of appropriately trained paediatric sub-specialists, specifically critical care practitioners and hepatologists.
  
  
  METHODS
  Subsequent to institutional approval, a retrospective chart analysis of all paediatric liver transplants performed at our facility to date was conducted.
  
  
  RESULTS
  Defining children as those under 18 years of age, 29 patients have received a cadaveric liver transplant since 2005, using 16 whole livers, 10 reduced-size grafts, and 3 split segments; 13 were transplanted with biliary atresia, 3 hyperoxalurea, 3 autosomal recessive polycystic disease, 2 alpha-1 antitrypsin deficiency, and 2 idiopathic, with the remainder for a wide spectrum of other pathologies. Seven patients received combined liver-kidney transplants. There were 3 in-hospital mortalities. The remaining 26 patients are all long-term survivors. We describe 7 acute surgical morbidities in 6 patients, and 8 long-term surgical morbidities. One patient was subsequently re-transplanted in Cape Town.
  
  
  CONCLUSIONS
  Despite a shortage of organs, we have overcome a steep learning curve, with results comparable with other early series. The current threat to the continued viability of our unit is the lack of appropriately trained paediatric hepatologists and intensivists.
authors.affiliation: Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. loveland@wol.co.za
authors.forename: J A
authors.initials: JA
authors.lastname: Loveland
authors.forename: T
authors.initials: T
authors.lastname: Govender
authors.forename: J
authors.initials: J
authors.lastname: Botha
authors.forename: R
authors.initials: R
authors.lastname: Britz
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D006959:Hyperoxaluria / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D017044:Polycystic Kidney, Autosomal Recessive / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome; D019896:alpha 1-Antitrypsin Deficiency / Q000601:surgery