Living donor liver transplantation in children: a single North American center experience over two decades.
Little data concerning hospital charges and long-term outcomes of LDLT in North American children according to transplant indications have been published. To compare outcomes of patient and graft survival and healthcare charges for LDLT for those with BA vs. other diagnoses (non-BA). A retrospective review of 52 children receiving 53 LDLT (38 BA and 14 non-BA) from 1992 to 2010 at our institution was performed. One-, five-, and 10-yr patient and graft survival data were comparable to national figures reported to UNOS. Average one-yr charges for recipients and donors were $242 849 for BA patients and $183 614 for non-BA (p = 0.074). BA patients were 1.23 ± 1.20 yr of age vs. 4.25 ± 5.02 for non-BA, p = 0.045. Examination of the total population of patients who were alive in 2010 in five chronological groupings showed that the crude five-yr survival rates were 1992-1995: 9/11 (82%); 1995-1997: 6/10 (60%); 1997-1999: 8/10 (80%); 1999-2001: 9/10 (90%); and 2001-2003: 7/7 (100%). Thus, examination of the clinical and financial data together over the entire period of the transplant program suggests that the dramatic improvement in patient survival was accomplished without a dramatic increase in indexed charges. All 53 donors survived, and only 10% had complications requiring hospitalization. LDLT in children results in excellent outcomes for patients and donors. Ways to lower costs and maximize graft outcome should be investigated.
Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA. wkarnsa1@jhmi.edu
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W
Karnsakul
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Intihar
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Konewko
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A
Roy
P M
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Colombani
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H
Lau
K B
KB
Schwarz
D000293:Adolescent; D001656:Biliary Atresia / Q000150:complications* / Q000191:economics / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality; D019520:Living Donors; D008297:Male; D008396:Maryland; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult