End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children.
Pediatric cadaver-organ-donor shortage has prompted evolution in liver transplantation technique. This has occurred in both living-donor liver transplantation (LDLT) and split-liver transplantation (SLT).
In this study, researchers from Italy evaluated 127 children with ESCLD for liver transplantation, between 1997 and 2001. Of these, 124 underwent 138 liver transplantations after a median time of 40 days.
The team found that the causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8).
Of the 124 patients, 73% received a split-liver graft, 23% a whole liver, and 4% a reduced-size liver.
|4-year patient survival:|
- split-liver = 91%
- whole-liver = 93%
- reduced-sized liver = 67%
The researchers found that 2- and 4-year patient survival rates were 93% and 91%, respectively. The 2- and 4-year graft-survival rates were 84% and 80%, respectively.
In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively. These survival rates were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients.
The team determined that the retransplantation rate was 11%, while mortality was 8%.
Overall, they found that the incidence of vascular and biliary complication were 16% and 27%, respectively.
Dr Bruno Gridelli's team concluded, "SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list".
"The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level".