Lessons from the first 100 liver transplantations in children at Bicêtre Hospital

J Pediatr Surg. 1994 Jul;29(7):905-11. doi: 10.1016/0022-3468(94)90013-2.

Abstract

The authors report their experience with 100 liver transplantations at Bicêtre Hospital. From 1988 to 1991, 85 children received a total of 100 liver grafts (mean age, 44.4 months; two thirds were under 3 years of age). Fifty-four percent of the grafts were reduced-size. Cyclosporine, steroids, and azathioprine were used for immunosuppression. The actuarial survival rate at 4 years is 86%. Retransplantation was performed in 14 children (16%). Forty-four patients (49%) had another operation. Biliary complications (17%), hepatic artery thrombosis (HAT) (14%), and hemoperitoneum (14%) were the most frequent surgical complications. Retransplantation was avoided in 50% of the patients who underwent urgent artery revision for thrombotic complications. It appeared that ABO-incompatible were better tolerated in children without ABO alloantibodies at the time of transplantation. The survival rates of ABO-identical, -compatible, and -incompatible liver grafts did not differ (61%, 50%, and 57% respectively). The results suggest that an aggressive policy of reintervention, including retransplantation, is necessary to achieve a satisfactory survival rate and quality of life. Children lacking ABO alloantibodies at the time of transplantation might tolerate ABO-incompatible liver grafts better.

MeSH terms

  • ABO Blood-Group System
  • Actuarial Analysis
  • Adolescent
  • Child
  • Child, Preschool
  • France / epidemiology
  • Humans
  • Immunosuppression
  • Immunosuppressive Agents / administration & dosage
  • Infant
  • Liver Diseases / mortality
  • Liver Diseases / surgery*
  • Liver Transplantation* / mortality
  • Liver Transplantation* / statistics & numerical data
  • Postoperative Complications / epidemiology
  • Reoperation
  • Survival Rate

Substances

  • ABO Blood-Group System
  • Immunosuppressive Agents