Long-Term Outcomes of Pediatric Living Donor Liver Transplantation in Japan: An Analysis of More Than 2200 Cases Listed in the Registry of the Japanese Liver Transplantation Society

Abstract

The Japanese Liver Transplantation Society (JLTS) was established in 1980 in order to characterize and follow trends in patient characteristics and graft survival among all liver transplant patients in Japan. This study analyzed the comprehensive factors that may influence the outcomes of pediatric patients who undergo living donor liver transplantation (LDLT) by evaluating the largest cohort in the world. Between November 1989 and December 2010, 2224 pediatric patients underwent LDLT in Japan. There were 998 male (44.9%) and 1226 female donors (55.1%) without donor mortalities related to transplant surgery. There were 946 male (42.5%) and 1278 female (57.5%) recipients with a median age of 4.0 years (range: 13 days to 17.9 years). Cholestatic liver disease was the leading indication for LDLT (n = 1649; 76.2%), followed by metabolic disorders (n = 194; 8.7%), acute liver failure (n = 192; 8.6%) and neoplastic liver disease (n = 66; 3.0%). The 1‐, 5‐, 10‐ and 20‐year patient survival rates were 88.3%, 85.4%, 82.8% and 79.6%, respectively. Blood‐type incompatibility, recipient age, etiology of liver disease and transplant era were found to be significant predictors of overall survival. We are able to achieve satisfactory long‐term pediatric patient survival outcomes in the JLTS series without compromising the living donors.

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“…The LDLT survival rates have been similar to survival rates in DDLT recipients, for both adult and pediatric populations, 8,9,[14][15][16][17] with similar 1-, 3-, and 5 year survival rates compared to United States data in both LDLT and DDLT (Table 5). The most important factor affecting recipient outcome is recipient PELD/MELD score at the time of LT.…”

“…5,7 The primary cause of liver failure in our pediatric recipients was biliary atresia (30.4%) ( Table 1), which is similar to other regions in the world. 5,[7][8][9][10] In the early days of transplant, deceased donors were the only donor resource. With time, due to the growing gap between the number of available deceased donors and patients requiring LT, the transplant community developed new donor resources, resulting in use of split livers, expandedcriteria donors, donation after circulatory death (DCD), and living donors.…”

Platelets Activation and Liver Transplantation

“…Furthermore, they reported that graft liver dysfunction was the most useful independent predictor of a nadir of platelet counts after LT, although various mechanisms of thrombocytopenia were proposed. Following this report, two additional studies [22,23] confirmed that severe thrombocytopenia after LT was associated with graft loss or a poor patient outcome. However, the precise mechanisms by which post-transplant thrombocytopenia occurs and its relationship with graft dysfunction remain unclear.…”

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“…8,9 Most grafts were obtained from living donors. A narrow organ donor pool is the most common problem that limits transplant in our country and around the world.…”