Arch Surg 1996 Aug;131(8):887-92; discussion 892-3

Decreased mortality from technical failure improves results in pediatric live
transplantation

Kuang AA, Rosenthal P, Roberts JP, Renz JF, Stock P, Ascher NL, Emond JC
Department of Surgery, University of California, San Francisco, USA

Abstract
BACKGROUND: Until recently, pediatric liver transplantation was associated with
a high rate of technical failure, which contributed substantially to the overall
prognosis. OBJECTIVE: To assess the impact of technical failure on outcome in
pediatric liver transplantation. DESIGN AND SETTING: We retrospectively analyzed
90 pediatric transplant procedures in a university medical center. PATIENTS:
Between February 1988 and December 1995, 80 children ( < 15 years old) received
90 transplants. Fifty-three percent (n = 42) were less than 2 years of age, 45%
(n = 36) had cholestatic liver disease, 26% (n = 21) had metabolic errors, and
11% (n = 9) had fulminant hepatitis. INTERVENTION: Patients underwent grafting
using previously reported techniques, including cadaveric whole (61% [n = 55]),
reduced-size (17% [n = 15]), and living related (22% [n = 20]) liver
transplantation. MAIN OUTCOME MEASURES: Patient and graft survival and selected
surgical complications. Outcomes were compared before (group 1) and after (group
2) the introduction of living related transplantation in July 1992. RESULTS: In
group 1, 32 patients received 36 grafts (4 retransplants [13%]), and in group 2,
48 patients received 54 grafts (6 retransplants [13%]). Six- and 12-month
patient survival rates were 78% (n = 25) and 75% (n = 24), respectively, for
group 1 and 98% (n = 47) and 94% (n = 45) for group 2. Of the 9 deaths in group
1, 6 occurred early as a consequence of surgical complications, while in group
2, all 5 deaths that occurred were caused by the consequences of
immunosuppression (lymphoproliferative disease, n = 2; late infections, n = 3).
CONCLUSIONS: These results suggest that mortality caused by surgical
complications has been reduced by improvement in management in recent years.
Living related grafts have supplemented the graft supply and may be associated
with the improved overall results. Despite these advances, children receiving
transplants continue to experience the consequences of imperfect
immunosuppression