title: Clinical and histological outcomes following living-related liver transplantation in children.
abstract: OBJECTIVE
  Living-related liver transplantation (LRLT) was developed to increase the donor pool of size-matched organs for children. In the UK only one centre performed LRLT between 1993 and 2008. This study reports the clinical and histological outcomes following adult-to-paediatric LRLT at our centre.
  
  
  METHODS
  Forty-six LRLTs were reviewed. Recipients had a mean age, weight and PELD score of 2.4years (range 0.5-11years), 11.0kg (3.7-32.3kg) and 11.7 (-20.3 to 49.1) respectively. The incidence of post-transplant paediatric morbidity, abnormal liver function tests and histological abnormalities was reviewed.
  
  
  RESULTS
  Patient and graft survival rates were 97.8%, 95.1% and 95.1%, and 97.8%, 92.1% and 71.7% at 1, 5 and 10years post-transplant respectively. Three children were re-transplanted at 44, 100 and 119months post-transplant. Nine children developed neuropsychological problems, 6 experienced educational difficulties, 5 developed post-transplant lymphoproliferative disorder and 5 suffered height or weight growth<2 centile. Normal LFTs were found in 41.7%, 50%, 68% and 64.7% of children at median follow-up of 6, 13, 61 and 85months respectively. Liver histology showed hepatitis, acute rejection, non-specific changes, biliary pathology, vascular pathology and chronic rejection in 32.9%, 29.5%, 13.4%, 10.1%, 6% and 2% of biopsies respectively.
  
  
  CONCLUSIONS
  The prevalence of paediatric morbidity and histological abnormalities emphasize the need for specialist and long-term follow-up following LRLT in children.
authors.affiliation: Paediatric Liver Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
authors.forename: Nikesh
authors.initials: N
authors.lastname: Dattani
authors.affiliation: Paediatric Liver Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom. Electronic address: alastair.baker@nhs.net.
authors.forename: Alastair
authors.initials: A
authors.lastname: Baker
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
authors.forename: Hector Vilca
authors.initials: HV
authors.lastname: Melendez
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
mesh_terms: D000328:Adult; D058445:Bullying; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006130:Growth Disorders / Q000453:epidemiology; D006505:Hepatitis / Q000473:pathology; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology*; D008102:Liver Circulation; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult