Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.583
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
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.
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.
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.
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.
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.
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.
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.