Paediatric living donor liver transplantation

Botha, Jean F.

doi:10.7196/samj.6261

Cited by 2 publications

(3 citation statements)

References 15 publications

(10 reference statements)

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“…From 1985 to 2004, 146 children underwent PLT in South Africa, with a reported 5‐year survival of >80% 47 . Some of the barriers to establishing a program described by the South African team included education of medical staff about the prevalence, severity, and treatment of PLD, improving surgical technique, resource shortages, and logistical limitations 47,53 . Last, expertise on the management of patients with concomitant infections such as HIV, HCV, HBV, and TB may be drawn upon from South African transplant colleagues.…”

Section: Discussionmentioning

confidence: 99%

“…37 Last, ensuring that rural patients have transportation and are able to manage complications and medications promptly and accurately is important for the success of the LT program. 37 Currently, Kenya performs living-donor kidney transplanta- 53 Last, expertise on the management of patients with concomitant infections such as HIV, HCV, HBV, and TB may be drawn upon from South African transplant colleagues.…”

Section: Con Clus Ionmentioning

confidence: 99%

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Examining need and capacity for the development of a pediatric liver transplantation program in Kenya

Muncner

Dell

Mwita³

et al. 2023

Pediatric Transplantation

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Background: In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program. Methods:A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web-based survey.Results: A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1-5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192-570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT. Conclusions:In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Con Clus Ionmentioning

confidence: 99%

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya

Muncner

Dell

Mwita³

et al. 2023

Pediatric Transplantation

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“…Simultaneously we approached the family for any potential living donors. If a potential living donor was eligible, and no deceased donor graft available, we proceeded with the living donor liver transplant procedure 14,15 . For recipients of ABO‐incompatible grafts, a protocolized treatment plan was followed to achieve and maintain IgG and IgM isoagglutinin titers less than or equal to 1:16 using therapeutic plasmapheresis, the frequency of which was dependent on daily titers, and Rituximab (375 mg/m 2 ) on days 4 and 10 post‐transplant, with standard immunosuppression comprising combination corticosteroid and tacrolimus.…”

Section: Methodsmentioning

confidence: 99%

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Bruckmann

Beretta

Demopolous

et al. 2020

Pediatric Transplantation

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Pediatric ALF is rare but life-threatening and may require urgent transplantation. In low and middle-income countries, access to transplantation is limited, deceased organ donation rates are low, and data on outcomes scarce. The Wits Donald Gordon Medical Centre, in Johannesburg, is one of only two centers in South Africa that perform pediatric liver transplant. We describe the etiology, clinical presentation, and outcomes of children undergoing liver transplant for ALF at our center over the past 14 years. We performed a retrospective chart review of all children undergoing liver transplantation for ALF from November 2005 to September 2019. Recipient data included demographics, clinical and biochemical characteristics pretransplant, post-operative complications, and survival. We conducted descriptive data analysis and used the Kaplan-Meier method for survival analysis. We performed 182 primary pediatric liver transplants. Of these, 27 (15%) were for ALF, mostly from acute hepatitis A infection (11/27;41%). Just over half of the grafts were from living donors (15/27;56%), and five grafts (5/27;19%) were ABO-incompatible. The most frequent post-transplant complications were biliary leaks (9/27;33%). There were two cases of hepatic artery thrombosis (2/27;7%), one of whom required re-transplantation. Unadjusted patient and graft survival at one and 3 years were the same, at 81% (95% CI 61%-92%) and 78% (95% CI 57%-89%), respectively. At WDGMC, our outcomes for children who undergo liver transplantation for ALF are excellent. We found workable solutions that effectively addressed our pervasive organ shortages without compromising patient outcomes.

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Paediatric living donor liver transplantation

Cited by 2 publications

References 15 publications

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya

Examining need and capacity for the development of a pediatric liver transplantation program in Kenya

Minding the gap—Providing quality transplant care for South African children with acute liver failure

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