Living donor liver transplantation during the first 3 months of life

Abstract

Living donor liver transplantation (LDLT) is now an established technique for treating children with end-stage liver disease. Few data exist about liver transplantation (LT) for exclusively young infants, especially infants of <3 months of age. We report our single-center experience with 12 patients in which LDLT was performed during the first 3 months of life and compare the results with those of older infants who underwent LT. All of the patients were treated at the National Center of Child Health and Development, Tokyo, Japan. Between November 2005 to November 2016, 436 children underwent LT. Twelve of these patients underwent LT in the first 3 months of life (median age, 41 days; median weight, 4.0 kg). The indications for transplantation were fulminant hepatic failure (n = 11) and metabolic liver disease (n = 1). All the patients received the left lateral segment (LLS) in situ to mitigate the problem of graft-to-recipient size discrepancy. A reduced LLS graft was used in 11 patients and a segment 2 monosegment graft was used in 1 patient. We compared the results with those of infants who were 4-6 months of age (n = 67) and 7-12 months of age (n = 110) who were treated in the same study period. There were significant differences in the Pediatric End-Stage Liver Disease score and the conversion rate of tacrolimus to cyclosporine in younger infants. Furthermore, the incidence of biliary complications, bloodstream infection, and cytomegalovirus infection tended to be higher, whereas the incidence of acute cellular rejection tended to be lower in younger infants. The overall cumulative 10-year patient and graft survival rates in recipients of <3 months of age were both 90.9%. LDLT during the first 3 months of life appears to be a feasible option with excellent patient and graft survival. Liver Transplantation 23 1051-1057 2017 AASLD.

Improved Survival Following Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Analysis of 20 Years of US National Registry Data

“…Additionally, mortality is high without liver transplantation (LT) . Transplantation in pediatric candidates with pediatric acute liver failure (PALF) is a more arduous prospect because technical and logistical features unique to children increase complexity of implantation, including donor/recipient size mismatch, poor availability of pediatric donors, and technical and ethical concerns surrounding living liver donation . As an ultimate treatment, LT has played a crucial role in saving patients with ALF.…”

Outcomes of Liver Transplantation in Small Infants

“…The main indication for LT in small infants (≤3 months) is ALF secondary to neonatal hemochromatosis . In the present series, this indication accounted for half of the patients in the XS group.…”

“…Many of these earlier studies showed that patient survival in the recipients <3 months of age was poorer and, thereby, contributed to the etiology of liver disease being different to that of older infants . However, other studies and present work have refuted this observation . Table summarizes the published literature and present series on LT in small infants ≤3 months old.…”

“…This study describes the short‐term and longterm outcomes of LT in infants 3 months old or younger in a single institution. Other centers have reported variable survival rates between 60% and 90.9% in small infants ≤3 months . Many of these earlier studies showed that patient survival in the recipients <3 months of age was poorer and, thereby, contributed to the etiology of liver disease being different to that of older infants .…”

“…To date, only a few groups have reported the outcomes following LT for infants <3 months of age. Many of these studies have been limited by small sample size, multicenter data, or short follow‐up . The aim of this study was to evaluate the short‐term and longterm outcomes of LT in small infants ≤6 months at a single transplant center.…”