August 1996

Decreased Mortality From Technical Failure Improves Results in Pediatric Liver Transplantation

Author Affiliations

From the Departments of Surgery (Drs Kuang, Roberts, Ascher, and Emond and Messrs Renz and Stock) and Pediatrics (Dr Rosenthal), University of California, San Francisco.

Arch Surg. 1996;131(8):887-893. doi:10.1001/archsurg.1996.01430200097017

Background:  Until recently, pediatric liver transplantation was associated with a high rate of technical failure, which contributed substantially to the overall prog

Objective:  To assess the impact of technical failure on outcome in pediatric liver transplantation.

Design and Setting:  We retrospectively analyzed 90 pediatric transplant procedures in a university medical center.

Patients:  Between February 1988 and December 1995, 80 children (<15 years old) received 90 transplants. Fifty-three percent (n=42) were less than 2 years of age, 45% (n=36) had cholestatic liver disease, 26% (n=21) had metabolic errors, and 11% (n=9) had fulminant hepatitis.

Intervention:  Patients underwent grafting using previously reported techniques, including cadaveric whole (61% [n=55]), reduced-size (17% [n= 15]), and living related (22% [n=20]) liver transplantation.

Main Outcome Measures:  Patient and graft survival and selected surgical complications. Outcomes were compared before (group 1) and after (group 2) the introduction of living related transplantation in July 1992.

Results:  In group 1, 32 patients received 36 grafts (4 retransplants [13%]), and in group 2, 48 patients received 54 grafts (6 retransplants [13%]). Six- and 12-month patient survival rates were 78% (n=25) and 75% (n=24), respectively, for group 1 and 98% (n=47) and 94% (n=45) for group 2. Of the 9 deaths in group 1, 6 occurred early as a consequence of surgical complications, while in group 2, all 5 deaths that occurred were caused by the consequences of immunosuppression (lymphoproliferative disease, n=2; late infections, n=3).

Conclusions:  These results suggest that mortality caused by surgical complications has been reduced by improvement in management in recent years. Living related grafts have supplemented the graft supply and may be associated with the improved overall results. Despite these advances, children receiving transplants continue to experience the consequences of imperfect immunosuppression.Arch Surg. 1996;131:887-893