Pediatric liver transplantation for acute liver failure at a single center: A 10-yr experience

Abstract

Children transplanted for acute liver failure (ALF) urgently require an optimal graft. Lower post-transplant survival compared to children transplanted for chronic liver disease. Over 10 years, 33 consecutive children transplanted for ALF were followed. Demographics, encephalopathy, intubation, dialysis, laboratory values, graft type (ABO incompatible grafts (ABOI), Large for size grafts(XL)(GRWR>5%),deceased donor segmental liver transplantation(DDSLT), living donor liver transplantation (LDLT) and whole liver transplant (WLT) were evaluated. Complications and survival were determined. ALF accounted for 33/201 (16.4%) of transplants during this period. 12/33 received ABOI, 5 XL grafts, 18 DDSLT, and 3 LDLT. Waiting time pre-transplant was 2.1 days. 1 and 3 year patient survival ALF group was 93% and 93% and graft survivals were 93 and 78.6%. Median follow-up was 1452 days. ABOI one and three year patient and graft survival in the ALF was 92 and 75%. No difference in graft or patient survival was noted in the ALF and chronic liver disease group nor the ABOI and the ABO compatible group. A combination of ABO incompatible donor livers, large for size grafts, DDSLT, LDLT and WLT led to a short wait time and subsequent graft and patient survival not significantly different than that for non-acute liver disease.

Invasive intracranial pressure monitoring is a useful adjunct in the management of severe hepatic encephalopathy associated with pediatric acute liver failure*

“…The pediatric intensive care unit at Children’s Healthcare of Atlanta at Egleston is a 30 bed multidisciplinary unit with average 1600 annual admissions. The liver transplant program performs transplants on an average of 22 patients per year and recently reported a 10-year experience of 33 liver transplants for ALF13. ALF was based on criteria from the Pediatric Acute Liver Failure study group (PALFSG) 1 and defined as acute onset of liver injury in children without history or evidence of chronic liver disease, with liver-associated coagulopathy in the presence or absence of encephalopathy.…”

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

“…In adults, LDLT has decreased waiting time for a variety of transplant indications, thus improving outcomes . TVG transplantation has also helped reduce the wait‐list mortality of pediatric candidates . LDLT has been studied in the overall pediatric population, regardless of liver disease etiology, and is shown to be associated with improved graft and patient survival .…”

A Importância da Referenciação Precoce na Falência Hepática Aguda Pediátrica

“…1,4,5 O TRH é o procedimento cirúrgico que, nas últimas décadas, permitiu uma significativa melhoria do seu prognóstico, aumentando a sobrevida para cerca de 60% -85%. 2,4,5,[10][11][12] Por ser rapidamente progressiva, um importante fator no prognóstico destas crianças é a sua referenciação precoce para um centro de transplantação hepática. 11,13,14 A abordagem multidisciplinar e diferenciada permite uma otimização das medidas de suporte de modo a evitar o TRH ou, no caso de ser inevitável, que a criança seja submetida a esse procedimento em melhores condições.…”

“…3,12,21 Atualmente, a FHA contribui para cerca de 15% dos TRH pediátricos, com uma significativa melhoria da sobrevida. 10,12 Há, no entanto, a salientar que o TRH, em caso de FHA, está associado a pior sobrevida quando comparado com as suas outras indicações (sobrevida a um ano de 74% na FHA vs 88,2% se TRH por outra causa). 4,21 Neste estudo, a sobrevida pós-TRH (78%) foi sobreponível à de outros centros europeus.…”