Indications for pediatric liver transplantation

Abstract

Two hundred fifty pediatric (less than 18 years of age) patients underwent orthotopic liver transplantation because of end-stage liver disease and were given combination therapy with cyclosporine and prednisone. The most common indications for transplantation in decreasing order of frequency were biliary atresia, inborn errors of metabolism, and postnecrotic cirrhosis. The 5-year actuarial survival for the entire group was 69.2%. Age and diagnosis did not influence survival. Infections were the most common cause of death, followed by liver failure and cerebrovascular accident. The impact of retransplantation on survival depends on the indication. The survival is better when retransplantation is carried out after rejection than because of technical complications, and the latter has a better survival than does primary graft nonfunction. The difference in survival among these groups is statistically significant. The quality of life for 164 of 173 survivors is good to excellent; only nine children are currently experiencing medical problems. A persistent problem in pediatric transplantation is the scarcity of small donors.

Figures

Fig. 1

Indications for hepatic transplantation in 250 pediatric patients treated with cyclosporine and prednisone combined.

Fig. 2

Actuarial survival (life table method) in 250 pediatric patients compared with that in 415 adult patients during cyclosporine era. Difference not statistically significant.

Fig. 3

Actuarial survival according to age grouptn 250 pediatric liver transplant recipients. Note that age has not influenced long-term survival thus far. Difference not statistically significant.

Fig. 4

Actuarial survival based on diagnostic indications for hepatiC transplantation in 250 pediatric patients. Difference among several groups not statistically significant.

Fig. 5

Actuarial survival of 67 pediatric patients who lost first graft, based on indication for retransplantation.