Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2023; 13(3): 96-106
Published online Mar 18, 2023. doi: 10.5500/wjt.v13.i3.96
Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study
Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia
Amr M Alnagar, Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria 21615, Egypt
Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia, Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
Author contributions: Alnagar AM and Hakeem AR contributed equally to this study; Alnagar AM and Attia MS conceived the study concept and design; Alnagar AM and Daradka K collected the data; Alnagar AM, Kyrana E, Methga M, and Palaniswamy K analyzed the data; Rajwal S, Mulla J, Upasani V, and Vijayanand D drafted the manuscript; Hakeem AR, Prasad R, O’meara M, and Attia MS critically revised the manuscript.
Institutional review board statement: Regarding institutional board acceptence, that was not required in view of the retrospective nature of the study for an already collected data without any patient identifiable data.
Informed consent statement: Informed consent is not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at abdul.hakeem1@nhs.net. Participants' consent was not obtained but the presented data are anonymized, and risk of identification is low.
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: Abdul R Hakeem, FRCS, PhD, FEBS, Consultant Hepatobiliary and Liver Transplant Surgeon, Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds City Centre-Beckett Street, Leeds LS9 7TF, United Kingdom. abdul.hakeem1@nhs.net
Received: December 2, 2022
Peer-review started: December 2, 2022
First decision: December 13, 2022
Revised: December 22, 2022
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: March 18, 2023
Processing time: 104 Days and 18.2 Hours
ARTICLE HIGHLIGHTS
Research background

Settings of pediatric liver transplantation (PLT) in end-stage chronic liver disease (ESCLD) and acute liver failure (ALF) are divergent. ALF recipients are transplanted within a narrow window of opportunity, whereas ESCLD recipients are usually transplanted electively.

Research motivation

Outcomes of PLT in ALF and ESCLD were previously described by different centers but to the best of our knowledge, they were not compared to establish if there is a difference in post-PLT survival and complication rates between these two groups.

Research objectives

To determine if there is a difference in post-operative complications and survival outcomes between the ALF and ESCLD in PLT.

Research methods

This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for the pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.

Research results

During the 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years vs 5.4 years; P = 0.031) and heavier (31 vs 21 kg; P = 0.011). Living donor grafts were used more in the ESCLD group (34 vs 0; P = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was considerably superior in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4% correspondingly compared to 78.3%, 78.3%, and 78.3% in the ALF group (P = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival rates between the ESCLD and ALF groups - 90.7%, 82.9%, and 77.3% vs 75.6%, 72.4%, and 66.9% (P = 0.119).

Research conclusions

Post-PLT survival in ALF patients is inferior to ESCLD patients. This may be due to several factors including uncertainty of the underlying pathology in most ALF patients and the more critical clinical status of ALF candidates in the immediate pre-transplant period. Survival post-PLT in the ALF group was adversely affected in the 1st year and then stabilized, while post-PLT survival in the ESCLD group showed a gradual decline over the study period.

Research perspectives

Future research should address the dilemma of identifying the underlying pathology in a considerable portion of ALF candidates and should also try to overcome liver graft shortage by identifying methods to widen the graft pool.