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©2009 The WJG Press and Baishideng.
World J Gastroenterol. Feb 14, 2009; 15(6): 648-674
Published online Feb 14, 2009. doi: 10.3748/wjg.15.648
Published online Feb 14, 2009. doi: 10.3748/wjg.15.648
Table 1 Series of pediatric reduced-size liver transplantation
Series | Period | n | Survival (%) | ReTX (%) | Complications (%) | ||||
Patient | Organ | HAT | PVT | BC | PNF | ||||
Broelsch et al[25] | 1984-1987 | 9 | 44 | 33 | 11 | 0 | 0 | 11 | 11 |
Otte et al[26] | 1984-1988 | 42 | 68 | 54 | 28 | 7 | 0 | NA | 5 |
Bismuth et al[22] | 1984-1988 | 14 | 50 | 44 | 14 | 7 | 7 | 14 | 7 |
Houssin et al[27] | 1986-1989 | 40 | 75 | 73 | - | 5 | 5 | 5 | 5 |
Kalayoglu et al[28] | 1988-1989 | 12 | 83 | 67 | 25 | 16 | 8 | 0 | 0 |
Esquivel et al[29] | 1988-1990 | 20 | 81 | 75 | 12 | 0 | 3 | 5 | 0 |
Langnas et al[30] | 1988-1991 | 29 | 68 | 65 | 3 | 7 | 0 | 20 | 10 |
Table 2 Series of pediatric living-related liver transplantation
Series | Period | n | Survival (%) | ReTX (%) | Complications (%) | ||||
Patient | Organ | HAT | PVT | BC | PNF | ||||
Tanaka et al[33] | 1990-1992 | 37 | E 90 U 57 | E 90 U 57 | 0 | U 14 | E 3 | E 10 | 0 |
Emond et al[34] | 1991-1992 | 18 | 94 | 84 | 16 | 11 | 6 | 16 | 0 |
Broelsch et al[35] | 1991 | 20 | 85 | 75 | 20 | 25 | 20 | 35 | 0 |
Malagò et al[36] | 1991-1994 | 36 | 72 | 72 | 8 | 2.8 | 3 | 25 | - |
Otte et al[37] | 1993-1995 | 30 | 97 | 93 | - | 20 | |||
Haberal et al[38] | 1990-1997 | 19 | 58 | 58 | 0 | 5 | 0 | 0 | 0 |
Darwish et al[39] | 1993-2002 | 100 | 94 | 92 | 3 | 1 | 14 | 27 | 0 |
Table 3 Series of ex situ split-liver transplantation
Series | Year | ADU (n) | PED (n) | Urgent (%) | Patient survival (%) | Graft survival (%) | Complications (%) | |||||
ADU | PED | ADU | PED | HAT | PVT | BC | PNF | |||||
Pichlmayr et al[40] | 1989 | 2 | 0 | 0 | 50 | - | 50 | - | 0 | 0 | 0 | 0 |
Bismuth et al[41] | 1989 | 2 | 0 | 100 | 0 | - | 0 | - | 0 | 0 | 0 | 0 |
Otte et al[42] | 1990 | 1 | 3 | 75 | 0 | 66 | 0 | 66 | 0 | 0 | 0 | 0 |
Emond et al[16] | 1990 | 5 | 13 | 38 | 40 | 63 | 40 | 53 | 6 | 6 | 27 | 24 |
Broelsch et al[24] | 1990 | 4 | 21 | 40 | 25 | 66 | 20 | 48 | NA | NA | 27 | NA |
Langnas et al[30] | 1992 | 1 | 9 | 73 | NA | NA | NA | NA | 7 | 0 | 20 | 17 |
Houssin et al[43] | 1993 | 6 | 10 | 50 | 83 | 70 | 83 | 60 | 13 | 25 | 25 | 0 |
Otte et al[44] | 1994 | 11 | 18 | 27 | NA | NA | NA | NA | 10 | 0 | 17 | 10 |
Kalayoglu et al[45] | 1996 | 5 | 7 | 8 | 100 | 85 | 80 | 71 | 8 | 0 | 17 | 0 |
Rogiers et al[46] | 1996 | 5 | 7 | 44 | 57 | 100 | 42 | 100 | 15 | 0 | 15 | 0 |
Azoulay et al[47] | 1996 | 26 | 1 | 14 | 80 | 100 | 76 | 100 | 15 | 0 | 22 | 4 |
Dunn et al[48] | 1997 | 0 | 12 | 50 | 75 | 66 | 0 | 0 | 0 | 0 | ||
Rela et al[49] | 1998 | 15 | 26 | 12 | 93 | 89 | 93 | 84 | 3 | 0 | 15 | 0 |
Mirza et al[50] | 1998 | 10 | 14 | 58 | 80 | 78 | NA | NA | 8 | 0 | 8 | 16 |
Chardot et al[51] | 1999 | 0 | 15 | 31 | - | 66 | - | 62 | 12 | 19 | 25 | 0 |
Reyes et al[52] | 2000 | 13 | 12 | 66 | 69 | 66 | 61 | 50 | 12 | 0 | 8 | NA |
Deshpande et al[53] | 2002 | 0 | 80 | 20 | - | 89 | - | 86 | 5 | 1 | 9 | 0 |
Noujaim et al[54] | 2003 | 24 | 36 | 25 | NA | NA | NA | NA | 3 | 0 | 20 | 3 |
Oswari et al[55] | 2005 | 0 | 30 | 13 | - | 70 | - | 67 | 2 | 5 | 7 | NA |
Table 4 Series of in situ split-liver transplantation
Series | Year | ADU (n) | PED (n) | Urgent (%) | Patient survival (%) | Graft survival (%) | Complications (%) | |||||
ADU | PED | ADU | PED | HAT | PVT | BC | PNF | |||||
Rogiers et al[56] | 1996 | 7 | 7 | 35 | 100 | 85 | 85 | 71 | 0 | 0 | 0 | 0 |
Goss et al[57] | 1997 | 14 | 12 | 58 | 85 | 100 | 78 | 91 | 0 | 0 | 14 | 11 |
Busuttil et al[58] | 1999 | NA | NA | 66 | 85 | 96 | 86 | 75 | 3 | 1 | 3 | 8 |
Ghobrial et al[59] | 2000 | 51 | 51 | 49 | 83 | 78 | NA | NA | 2 | 2 | NA | 8 |
Reyes et al[52] | 2000 | NA | NA | NA | 93 | 100 | 79 | 83 | 3 | 0 | 3 | 7 |
Spada et al[60] | 2000 | 36 | 35 | 25 | 84 | 85 | 79 | 76 | 5 | 10 | 28 | 2 |
Gridelli et al[61] | 2003 | 0 | 90 | 28 | - | 90 | - | 80 | 7 | 6 | 33 | 1 |
Yersiz et al[62] | 2003 | 57 | 104 | - | 78 | 75 | 69 | 64 | 13 | 11 | 19 | 26 |
Table 5 Banff grading of acute liver allograft rejection
Assessment | Criteria | RAI |
Indeterminate | Portal inflammatory infiltrate that fails to meet criteria for the diagnosis of acute rejection | 1-2 |
Mild | Rejection infiltrate in a minority of the triads that is generally mild and confined within the portal spaces | 3-4 |
Moderate | Rejection infiltrate expanding most or all of the triads | 5-6 |
Severe | As above for moderate, with spillover into the periportal areas and moderate to severe perivenular inflammation that extends into the hepatic perenchyma and is associated with perivenular hepatocyte necrosis | > 6 |
Table 6 Rejection activity index (RAI)
Category | Criteria | Score |
Portal inflammation | Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads | 1 |
Expansion of most or all of the triads by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils, and eosinophils | 2 | |
Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and eosinophils with inflammatory spillover into the periportal parenchyma | 3 | |
Bile duct inflammation damage | A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes such as an increased nuclear-to-cytoplasmatic ratio of the epithelial cells | 1 |
Most or all of the ducts infiltrated by inflammatory cells. More than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity, and cytoplasmatic vacuolization of the epithelium | 2 | |
As above for the 2nd criterion, with most or all of the ducts showing degenerative changes or focal luminal disruption | 3 | |
Venous endothelial inflammation | Subendothelial lymphocytic infiltration involving some, but not a majority, of the portal and/or hepatic venules | 1 |
Subendothelial infiltration involving most or all of the portal and/or hepatic venules | 2 | |
As above for the 2nd criterion, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis | 3 |
Table 7 Literature review of immunosuppressive protocol with steroid weaning after pediatric liver transplantation
Author | Year | Patients (n) | Protocol | Weaning (%) | Graft loss | Rejection (%) | ||
Performed | Success | Acute | Chronic | |||||
Margarit et al[110] | 1989 | 18 | CsA+Aza | 83 | 61 | 13% | 27 | 13 |
Andrews et al[111] | 1994 | 119 | CsA+Aza1 | 44 | 67 | No | 13 | No |
Dunn et al[112] | 1994 | 73 | CsA+Aza | 51 | 76 | 4% | 7 | 4 |
McDiarmid et al[113] | 1995 | 13 | CsA+Aza | No | No | No | ||
McKee et al[114] | 1997 | 29 | TAC | 83 | 71 | 29 | ||
Martin et al[115] | 1998 | 55 | CsA+Aza | 44 | 76 | No | 11 | No |
Reding et al[109116] | 2000 | 375 | CsA (n = 23) | 21 | No | No | No | |
CsA-ME (n = 24) | No | No | No | |||||
TAC (n = 31) | No | 10 | No | |||||
Atkison et al[117] | 2002 | 94 | CsA+Aza2 | 71 | 91 | 21 | ||
Toyoki et al[118] | 2004 | 8 | TAC | 100 | 100 | No | 13 | No |
Table 8 Desired trough concentrations of calcineurin inhibitors after pediatric liver transplantation
Time post-transplant (mo) | Target level (mg/L) | |
Cyclosporine | Tacrolimus | |
0-3 | 200-250 | 10-15 |
4-12 | 150-200 | 8-10 |
> 12 | 50-100 | 5-8 |
Table 9 Use of sirolimus in primary immunosuppressive regimens in liver transplantation
Author | Immunosuppression | No. of patients | Survival (%) | Acute rejection (%) | Follow-up (mo) | |
Patient | Graft | |||||
McAlister et al[153] | TRL, SRL, STER1 | 32 | 92 | 3 | 8 | |
McAlister et al[154] | TRL, SRL, STER1 | 56 | 93 | 91 | 14 | 23 |
Peltekian et al[155] | TRL, SRL, STER1 | 42 | 93 | 90 | 10 | 14 |
Pridöhl et al[156] | TRL, SRL, STER | 22 | 91 | 78 | 14 | 14 |
Sindhi et al[157] | TRL, early SRL, STER | 6 | 17 | 15 | ||
TRL, late SRL, ATG | 9 | 332 | 3 |
Table 10 Use of IL-2 receptor antibodies in primary immunosuppressive regimens in pediatric liver transplantation
Author | Immunosuppression | No. of patients | Survival (%) | Acute rejection (%) | Follow-up (mo) | |
Patient | Graft | |||||
Asensio et al[167] | TRL, STER | 21 | 80 | 80 | 63 | 12 |
TRL, STER, BAS | 34 | 80 | 80 | 30 | ||
Strassburg et al[168] | TRL, STER | 12 | 42 | 28 | ||
CSA, STER, AZA | 9 | 66 | ||||
CSA, STER | 12 | 42 | ||||
CSA, STER, BAS | 21 | 33 | ||||
Heffron et al[169] | TRL, MMF, STER | 20 | 85 | 88 | 50 | 24 |
TRL,2 MMF, DAC, STER | 61 | 93 | 73 | 15 | ||
Reding et al[119] | TRL, STER | 20 | 50 | 12 | ||
TRL, BAS, MMF1 | 20 | 25 | ||||
Ganschow et al[170171] | CSA, STER | 54 | 94 | 54 | 28-52 | |
CSA, STER, BAS | 54 | 98 | 17 | |||
Schuller et al[172] | TRL, MMF, STER | 12 | 66 | 14 | ||
TRL, MMF, DAC, STER | 18 | 0 | 6 | |||
Spada et al[120] | TRL, STER | 36 | 91 | 86 | 32 | 24 |
TRL, BAS | 36 | 87 | 80 | 12 |
Table 11 Common causes of late dysfunction in the pediatric population
Incidence at 5 yr (%) | Risk factors | |
Acute rejection | Variable (< 30) | Inadequate immunosuppression |
Treatment with immune activating drugs (e.g. interferon) | ||
History of autoimmune liver disease | ||
Chronic rejection | -3 | Inadequate immunosuppression |
Treatment with immune-activating drugs (e.g. interferon) | ||
Refractory acute rejection | ||
Chronic rejection in a previous failed allograft | ||
Recurrent AIH | -30 | Suboptimal immunosuppression |
AIH type I | ||
Severe inflammation in native liver | ||
HLA DR3 or DR4 | ||
De novo AIH | < 5 | |
Recurrent PBC | 20-30 | Tacrolimus as baseline immunosuppression |
Living-related donor | ||
Steroid and other immunosuppression withdrawal | ||
Recurrent PSC | 20-30 | Male sex; donor-recipient gender mismatch |
Intact colon at time of transplantation | ||
Idiopathic post-transplant hepatitis | 5-60 |
Table 12 UNOS pediatric liver Kaplan-Meier patient and graft survival rates for transplants performed between 1997 and 2004
Recipient age (yr) | Patient survival (yr) | Graft survival (yr) | ||||
1 | 3 | 5 | 1 | 3 | 5 | |
< 1 | 89 | 82 | 78 | 81 | 70 | 63 |
1-5 | 86 | 80 | 77 | 78 | 71 | 67 |
6-10 | 91 | 86 | 86 | 84 | 76 | 75 |
11-17 | 93 | 87 | 81 | 87 | 77 | 67 |
- Citation: Spada M, Riva S, Maggiore G, Cintorino D, Gridelli B. Pediatric liver transplantation. World J Gastroenterol 2009; 15(6): 648-674
- URL: https://www.wjgnet.com/1007-9327/full/v15/i6/648.htm
- DOI: https://dx.doi.org/10.3748/wjg.15.648