The Largest Single Center Report on Pediatric Liver Transplantation

Abstract

Objective: We described our experiences on pediatric liver transplantation (LT) from the largest LT center in the world termed the Shiraz Transplant Center. Background: After the first successful pediatric LT in 1967, pediatric LT has become the routine treatment for children with liver failure worldwide. Methods: Data on a total of 1141 pediatric cases of LT were collected. Specifics on baseline and anthropometric characteristics, clinicopathology, prognosis of recipients of LT, and donor characteristics are reported. Results: Mean age of patients was 7.83 ± 5.55 years old. Most common etiologies for LT were biliary atresia (15.9%), progressive familial intrahepatic cholestasis (13.4%), and Wilson's disease (13.3%), respectively. Whole organs, living donor grafts, and split grafts were used in 47.9%, 41%, and 11.1% of patients, respectively. In-hospital complications were seen among 34.7% of patients and the most common complications were infections (26.8%), bleeding (23.4%), and vascular complications (18%). Median (interquartile range) model for end stage liver disease score was 20 (15, 25). Main causes of death among patients were sepsis (35.2%), followed by post-transplantation lymphoproliferative diseases (10.5%), and primary nonfunction of liver (9%). Patient survival showed improvement over the years (1-year survival of 73.1%, 83.4%, and 84.4%, 2-year survival of 65.2%, 77.1%, and 78.7%, 5-year survival of 58.2%, 72%, and 77.8% for 1997–2007, 2007–2013, and 2013–2019, respectively; P < 0.001). Conclusions: This is the largest single-center report on pediatric LT in literature which provides valuable experiences in pediatric LT.

Pediatric liver transplantation and COVID-19: a case report

“…Infection rates after liver transplantation among the pediatric population are variable between studies. Nikeghbalian et al [5] reported in-hospital infection rates in a large series of pediatric patients to be 9.4%, moreover infections constituted 35.2% of all causes of death in this population. Another experience from Korea reported the 6 month infection rate among pediatric patients to be 44.2% and similar to the previous report infections were the most common cause of death (50%) [6].…”

HO-1/BMMSC perfusion using a normothermic machine perfusion system reduces the acute rejection of DCD liver transplantation by regulating NKT cell co-inhibitory receptors in rats

“…The probability of acute rejection (ACR) remains 20-40% without the application of an effective immunosuppressive regimen following LT [7]. Long-term immunosuppressant use is required, which has associated complications (e.g., renal injury, abnormal metabolic syndrome, de novo tumors), and the long-term outcomes remain unsatisfactory [8][9][10][11]. There is a need to explore effective immunomodulatory means to induce immune tolerance in LT, mitigate ACR, and decrease or avoid the use of immunosuppressive agents.…”

A bibliometric analysis of infectious diseases in patients with liver transplantation in the last decade

“…The most common etiologies for LT were alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), and hepatitis C virus (HCV) (4)(5)(6). For pediatric patients, the leading cause of LT was biliary atresia (7). Posttransplantation infections often occur after LT, with an incidence ranging from 5% to 48% due to the application of immunosuppressants and glucocorticoids (8,9).…”