Clinical and histological outcomes following living-related liver transplantation in children

摘要

Objectives: Living-related liver transplantation (LRLT) was developed to increase the donor pool of size-matched organs for children. In the UK only one centre performed LRLT between 1993 and 2008. This study reports the clinical and histological outcomes following adult-to-paediatric LRLT at our centre. Methods: Forty-six LRLTs were reviewed. Recipients had a mean age, weight and PELD score of 2.4. years (range 0.5-11. years), 11.0. kg (3.7-32.3. kg) and 11.7 (-20.3 to 49.1) respectively. The incidence of post-transplant paediatric morbidity, abnormal liver function tests and histological abnormalities was reviewed. Results: Patient and graft survival rates were 97.8%, 95.1% and 95.1%, and 97.8%, 92.1% and 71.7% at 1, 5 and 10. years post-transplant respectively. Three children were re-transplanted at 44, 100 and 119. months post-transplant. Nine children developed neuropsychological problems, 6 experienced educational difficulties, 5 developed post-transplant lymphoproliferative disorder and 5 suffered height or weight growth. < 2 centile. Normal LFTs were found in 41.7%, 50%, 68% and 64.7% of children at median follow-up of 6, 13, 61 and 85. months respectively. Liver histology showed hepatitis, acute rejection, non-specific changes, biliary pathology, vascular pathology and chronic rejection in 32.9%, 29.5%, 13.4%, 10.1%, 6% and 2% of biopsies respectively. Conclusions: The prevalence of paediatric morbidity and histological abnormalities emphasize the need for specialist and long-term follow-up following LRLT in children.