Live donor liver transplantation for pediatric acute liver failure : challenges and outcomes
© 2023. Asian Pacific Association for the Study of the Liver..
OBJECTIVE: This study aimed at studying the challenges and outcomes of live-donor liver transplantation (LDLT) for pediatric acute liver failure (PALF).
STUDY DESIGN: A total of 315 patients with PALF were treated over a period of 11 years. 42 underwent LT (41 LDLT and one DDLT), constituting 38% (41/110) of all pediatric transplants during this duration. The outcomes of LDLT for PALF were analyzed.
RESULTS: All the 41 children who underwent LT met the Kings College criteria (KCC). The etiology was indeterminate in 46.3% (n = 19) children. 75.6% (n = 31) were on mechanical ventilation for grade 3/4 hepatic encephalopathy. There was presence of cerebral edema on a computed tomography scan of the brain in 50% of the children. One-third of our children required hemodynamic support with vasopressors. Systemic inflammatory response syndrome and sepsis were observed in 46.3% and 41.4% of patients, respectively. Post-LDLT 1- and 5-yr patient and graft survival were 75.6% and 70.9%, respectively. The survival in children satisfying KCC but did not undergo LT was 24% (38/161). Vascular and biliary complication rates were 2.4% and 4.8%, respectively. No graft loss occurred because of acute rejection. In multivariate analysis, pre-LT culture positivity and cerebral edema, persistence of brain edema after transplantation, and resultant pulmonary complications were significantly associated with post-LT death. Thirteen (32%) children who underwent plasmapheresis prior to LT had better post-LT neurological recovery, as evidenced by early extubation.
CONCLUSION: LDLT for PALF is lifesaving and provides a unique opportunity to time transplantation. Good long-term survival can be achieved, despite the majority of patients presenting late for transplantation. Early referral and better selection can save more lives through timely transplantation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Hepatology international - 17(2023), 6 vom: 01. Dez., Seite 1570-1586 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pamecha, Viniyendra [VerfasserIn] |
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| Links: |
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| Themen: |
Brain edema |
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| Anmerkungen: |
Date Completed 22.11.2023 Date Revised 13.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s12072-023-10571-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360864821 |
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| 100 | 1 | |a Pamecha, Viniyendra |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Live donor liver transplantation for pediatric acute liver failure |b challenges and outcomes |
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| 500 | |a Date Revised 13.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. Asian Pacific Association for the Study of the Liver. | ||
| 520 | |a OBJECTIVE: This study aimed at studying the challenges and outcomes of live-donor liver transplantation (LDLT) for pediatric acute liver failure (PALF) | ||
| 520 | |a STUDY DESIGN: A total of 315 patients with PALF were treated over a period of 11 years. 42 underwent LT (41 LDLT and one DDLT), constituting 38% (41/110) of all pediatric transplants during this duration. The outcomes of LDLT for PALF were analyzed | ||
| 520 | |a RESULTS: All the 41 children who underwent LT met the Kings College criteria (KCC). The etiology was indeterminate in 46.3% (n = 19) children. 75.6% (n = 31) were on mechanical ventilation for grade 3/4 hepatic encephalopathy. There was presence of cerebral edema on a computed tomography scan of the brain in 50% of the children. One-third of our children required hemodynamic support with vasopressors. Systemic inflammatory response syndrome and sepsis were observed in 46.3% and 41.4% of patients, respectively. Post-LDLT 1- and 5-yr patient and graft survival were 75.6% and 70.9%, respectively. The survival in children satisfying KCC but did not undergo LT was 24% (38/161). Vascular and biliary complication rates were 2.4% and 4.8%, respectively. No graft loss occurred because of acute rejection. In multivariate analysis, pre-LT culture positivity and cerebral edema, persistence of brain edema after transplantation, and resultant pulmonary complications were significantly associated with post-LT death. Thirteen (32%) children who underwent plasmapheresis prior to LT had better post-LT neurological recovery, as evidenced by early extubation | ||
| 520 | |a CONCLUSION: LDLT for PALF is lifesaving and provides a unique opportunity to time transplantation. Good long-term survival can be achieved, despite the majority of patients presenting late for transplantation. Early referral and better selection can save more lives through timely transplantation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Brain edema | |
| 650 | 4 | |a Hepatic encephalopathy | |
| 650 | 4 | |a Live-donor liver transplantation | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Pediatric acute liver failure | |
| 650 | 4 | |a Plasmapheresis | |
| 700 | 1 | |a Patil, Nilesh Sadashiv |e verfasserin |4 aut | |
| 700 | 1 | |a Falari, Sanyam |e verfasserin |4 aut | |
| 700 | 1 | |a Mohapatra, Nihar |e verfasserin |4 aut | |
| 700 | 1 | |a Kumar, Anubhav Harshit |e verfasserin |4 aut | |
| 700 | 1 | |a Sindwani, Gaurav |e verfasserin |4 aut | |
| 700 | 1 | |a Garg, Neha |e verfasserin |4 aut | |
| 700 | 1 | |a Alam, Seema |e verfasserin |4 aut | |
| 700 | 1 | |a Khanna, Rajeev |e verfasserin |4 aut | |
| 700 | 1 | |a Sood, Vikrant |e verfasserin |4 aut | |
| 700 | 1 | |a Lal, Bikrant Bihari |e verfasserin |4 aut | |
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