Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2022; 14(3): 583-591
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.583
Pediatric liver transplantation outcomes from a single center in Thailand
Sittichoke Prachuapthunyachart, Palittiya Sintusek, Chomchanat Tubjareon, Nataruks Chaijitraruch, Anapat Sanpavat, Teerasak Phewplung, Piyaporn Wanawongsawad, Ai-lada Intrarakamhang, Voranush Chongsrisawat
Sittichoke Prachuapthunyachart, Palittiya Sintusek, Chomchanat Tubjareon, Voranush Chongsrisawat, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Palittiya Sintusek, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Chulalongkorn University, Bangkok 10330, Thailand
Nataruks Chaijitraruch, Piyaporn Wanawongsawad, Ai-lada Intrarakamhang, Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Anapat Sanpavat, Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Teerasak Phewplung, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Author contributions: Prachuapthunyachart S designed the study, drafted the initial manuscript, collected, interpreted and analyzed the data; Sintusek P, Tubjareon C, Chaijitraruch N, Sanpavat A, and Phewplung T revised the article critically for important intellectual content; Wanawongsawad P and Intrarakamhang A collected the data; Chongsrisawat V provided valuable advice and revised the article critically for important intellectual content; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (IRB approval number: 322/64).
Informed consent statement: The informed consent was waived for the study as approved by the IRB.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Voranush Chongsrisawat, MD, Associate Professor, Doctor, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873, Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. voranush.c@chula.ac.th
Received: August 1, 2021
Peer-review started: August 1, 2021
First decision: September 29, 2021
Revised: October 31, 2021
Accepted: February 19, 2022
Article in press: February 19, 2022
Published online: March 27, 2022
Processing time: 234 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background

Pediatric LT has been accepted as a curative method for children with several liver diseases. The success rates have improved due to better organ-preservation techniques, enhanced surgical skills, and the availability of newer immunosuppressive agents. Organ shortage has become a rising problem worldwide, especially in Eastern countries.

Research motivation

King Chulalongkorn Memorial Hospital is the leading hospital in Thailand for pediatric LT. Several reports on pediatric LT were noted in the United States, Europe, Middle East, and East Asian countries. However, data from South East Asia, especially related to ABO-incompatible LT, are scarce.

Research objectives

The current study aimed to report experiences with pediatric LT performed at the center of this study and evaluate outcomes of living-related vs deceased-donor grafts.

Research methods

The current retrospective study included 94 children who underwent LT and were followed up for a median time of 4 years thereafter. Data of donors and recipients, including postoperative complications and survival rates, were reviewed and analyzed.

Research results

In the current study, 94 pediatric LT performed at the center of this study were reported. The median age at transplantation was 1.2 (0.8-3.8) years. Most grafts (81.9%) were obtained from living-related donors. The median wait time for the living donors was significantly shorter than that for deceased donors at 1.6 (0.3-3.1) vs 11.2 (2.1-33.3) months (P = 0.01). Most patients were diagnosed with biliary atresia (74.5%), and infection was the most common complication within 30 d post-transplantation (14.9%). In addition, 9% of transplants were ABO-incompatible without a desensitization protocol. No observed different vascular, infection, or rejection complications were noted. Eight (8.5%) recipients who tested negative for HBc antibodies received positive anti-HBc grafts with no observed different infection or rejection complications. The overall survival rate was 93.6% and 90.3% at 1 and 5 years, respectively. No graft loss during follow-up was noted among the survivors.

Research conclusions

Living-donor-related LT has saved many lives with shorter wait times compared with deceased-donor surgeries. Based on relatively comparable outcomes, ABO-incompatible and HBc antibody-positive liver grafts may be considered in the face of organ shortages. The survival results in the previous 15 years are promising.

Research perspectives

The current study suggests that living-donor liver transplantation (LT) can save many lives and has a good outcome with shorter wait times in the face of organ shortage. ABO-incompatible LT can be considered in pediatric < 1-year-old recipients without a sensitization protocol. Hepatitis B core (HBc) antibody-positive liver grafts may also be used. Nonetheless, special attention should be focused on high titers of anti-hepatitis B surface before LT and lifelong postoperative antiviral prophylaxis. More studies on living-donor pediatric LT and protocols for these special donor groups are needed.