Current developments in pediatric liver transplantation

Hackl, Christina; Schlitt, Hans J.; Melter, Michael; Knoppke, Birgit; Loss, Martin

doi:10.4254/wjh.v7.i11.1509

Cited by 68 publications

(73 citation statements)

References 103 publications

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“…Adolescents receiving liver transplants have excellent long‐term survival rates, with >80% surviving more than 10 years, which is comparable to younger children and better than adult population . Nevertheless, it is important to identify and predict survival in those adolescents who have higher risk of mortality or graft loss in the immediate post‐transplant period using a post‐transplant survival scoring system.…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes scores (SOFT,BAR, and Pedi‐SOFT) are accurate in predicting post‐liver transplant survival in adolescents

Selvakumar

Maksimak

Hanouneh

et al. 2016

Pediatric Transplantation

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SOFT and BAR scores utilize recipient, donor, and graft factors to predict the 3-month survival after LT in adults (≥18 years). Recently, Pedi-SOFT score was developed to predict 3-month survival after LT in young children (≤12 years). These scoring systems have not been studied in adolescent patients (13-17 years). We evaluated the accuracy of these scoring systems in predicting the 3-month post-LT survival in adolescents through a retrospective analysis of data from UNOS of patients aged 13-17 years who received LT between 03/01/2002 and 12/31/2012. Recipients of combined organ transplants, donation after cardiac death, or living donor graft were excluded. A total of 711 adolescent LT recipients were included with a mean age of 15.2±1.4 years. A total of 100 patients died post-LT including 33 within 3 months. SOFT, BAR, and Pedi-SOFT scores were all found to be good predictors of 3-month post-transplant survival outcome with areas under the ROC curve of 0.81, 0.80, and 0.81, respectively. All three scores provided good accuracy for predicting 3-month survival post-LT in adolescents and may help clinical decision making to optimize survival rate and organ utilization.

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Section: Discussionmentioning

confidence: 99%

Survival outcomes scores (SOFT,BAR, and Pedi‐SOFT) are accurate in predicting post‐liver transplant survival in adolescents

Selvakumar

Maksimak

Hanouneh

et al. 2016

Pediatric Transplantation

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“…In Japan, from November 1989 to December 2015, 2085 patients with BA underwent LDLT, and the rates of 1-year, 5-year, 10-year, 15-year, and 20-year graft survival for the patients with BA were high 24. In addition to the technical progress, there were also associated change of the primary disease of pediatric recipients of LT, that is, the main indications for LT in children are congenital and metabolic disease 25. Besides, the 2016 annual report from the Scientific Registry of Transplant Recipients demonstrated 90.8% 1-year and 82.7% 5-year graft survival among pediatric liver transplant recipients 26.…”

Section: Introductionmentioning

confidence: 99%

How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

Zhan

Chen

Wong

2018

World Jnl Ped Surgery

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BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

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“…Liver transplantation is a well‐established treatment and a standard of care for children with end‐stage liver disease and liver‐based metabolic diseases. Improved surgical techniques, modern immunosuppressive regimens and highly developed peri‐ and postoperative intensive care increased success rates for long‐term patient survival up to 90% . Despite excellent survival rates, complications after pLT still occur.…”

Section: Introductionmentioning

confidence: 99%

Liver transplantation during infancy: No increased rate of neurological complications

Ameres¹,

Melter²,

Zant³

et al. 2018

Pediatric Transplantation

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pLT is a highly standardized therapy for children with end‐stage liver disease and liver‐based metabolic diseases. However, NCs after transplantation occur and especially younger children are considered as more vulnerable and susceptible to NCs. Up to now, detailed data particularly for the very young age group do not exist. We therefore retrospectively studied NCs in children after pLT under age of 24 months. Forty children aged between 19 days and 22 months were evaluated according to type of NC and potential risk factors. NCs occurred in 8/40 patients (20%). All experienced new‐onset seizures and in 1/6 surviving patients, seizures evolved into epilepsy. Other NCs were intracerebral abscess (1/8 patients) and subdural hemorrhage (1/8 patients). The overall 3‐year mortality rate was 10% (4/40 patients). Significant risk factors for NCs and therefore seizures were HAT (P = 0.020), total surgery time (P = 0.009), retransplantation (P < 0.001), period of catecholamine therapy (P = 0.024), period of mechanical ventilation (P = 0.014), and period of sedation (P = 0.010). Our study is the first to provide detailed information on NCs after pLT in children under 24 months of age. The incidence of NCs in this particular group of very young patients was not increased compared to previously published data of children of all ages. Main NC was new‐onset seizure. In the surviving infants, prognosis of seizure was excellent and the risk of developing epilepsy was low. Even more, the occurrence of NCs did not significantly affect mortality or survival in this particular age group.

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Current developments in pediatric liver transplantation

Cited by 68 publications

References 103 publications

Survival outcomes scores (SOFT,BAR, and Pedi‐SOFT) are accurate in predicting post‐liver transplant survival in adolescents

Survival outcomes scores (SOFT,BAR, and Pedi‐SOFT) are accurate in predicting post‐liver transplant survival in adolescents

How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

Liver transplantation during infancy: No increased rate of neurological complications

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