Improved outcomes in liver transplantation in children with acute liver failure.
OBJECTIVE
The aim of our study was to review the experiences of a living donor-dominant transplantation program for children with acute liver failure (ALF).


METHODS
Data were derived from the retrospective chart review of 50 children with ALF in a major liver center in the Republic of Korea.


RESULTS
A total of 50 children with ALF underwent 47 (94%) primary living donor liver transplantations and 3 (6%) cadaveric liver transplantations. The cumulative survival rates of the grafts at 1 and 5 years were 81.9% and 79.2%, respectively. The overall retransplantation rate was 12%. The cumulative survival rates of these patients at 1 and 5 years were all 87.9%. Most incidents of mortality followed the failure of the preceding graft. We observed no mortalities among donors. Based on multivariate analysis, children who had pretransplant thrombocytopenia or had to use the molecular adsorbent recycling system preoperatively were related to the graft loss. Age younger than 2 years and a hyperacute onset (within 7 days) of hepatic encephalopathy were associated with pretransplant thrombocytopenia.


CONCLUSIONS
Living donor-dominant transplantation program in the present study demonstrates tolerable achievements in terms of clinical outcomes of recipients and donors; however, putative factors, such as pretransplant thrombocytopenia, seem to play unclear roles in a poor prognosis following transplantation.
*Department of Pediatrics †Department of Pediatric Surgery ‡Department of Pediatric Radiology §Department of Radiology ||Department of Anesthesiology ¶Department of Pathology #Division of Hepato-Biliary Surgery and Liver Transplantation **Department of Surgery, Division of Hepato-Biliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Seak Hee
SH
Oh
Kyung Mo
KM
Kim
Dae Yeon
DY
Kim
Young
Y
Kim
Seung Min
SM
Song
Yeoun Joo
YJ
Lee
Seong-Jong
SJ
Park
Chong Hyun
CH
Yoon
Gi-Young
GY
Ko
Kyu-Bo
KB
Sung
Gyu-Sam
GS
Hwang
Kyu-Taek
KT
Choi
Eunsil
E
Yu
Gi-Won
GW
Song
Tae-Yong
TY
Ha
Deok-Bog
DB
Moon
Chul-Soo
CS
Ahn
Ki-Hun
KH
Kim
Shin
S
Hwang
Kwang-Min
KM
Park
Young-Joo
YJ
Lee
Sung-Gyu
SG
Lee
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000150:complications; D016896:Treatment Outcome