Abstract
ObjectivesLiving donor liver transplantation (LDLT) in patients with acute liver failure (ALF) has become an acceptable alternative to transplantation from deceased donors (DDLT). The aim of this study was to analyze outcomes of LDLT in pediatric patients with ALF based on our center’s experience.Material and methodsWe enrolled 63 children (at our institution) with ALF who underwent liver transplantation between 1997 and 2016. Among them 24 (38%) underwent a LDLT and 39 (62%) received a DDLT. Retrospectively analyzed patient clinical data included: time lapse between qualification for transplantation and transplant surgery, graft characteristics, postoperative complications, long-term results post-transplantation, and living donor morbidity. Overall, we have made a comparison of clinical results between LDLT and DDLT groups.ResultsFollow-up periods ranged from 12 to 182 months (median 109 months) for LDLT patients and 12 to 183 months (median 72 months) for DDLT patients. The median waiting time for a transplant was shorter in LDLT group than in DDLT group. There was not a single case of primary non-function (PNF) in the LDLT group and 20 out of 24 patients (83.3%) had good early graft function; 3 patients (12.5%) in the LDLT group died within 2 months of transplantation but there was no late mortality. In comparison, 4 out of 39 patients (10.2%) had PNF in DDLT group while 20 patients (51.2%) had good early graft function; 8 patients (20.5%) died early within 2 months and 2 patients (5.1%) died late after transplantation. The LDLT group had a shorter cold ischemia time (CIT) of 4 hours in comparison to 9.2 hours in the DDLT group (p<0.0001).ConclusionsLDLT is a lifesaving procedure for pediatric patients with ALF. Our experience showed that it may be performed with very good results, and with very low morbidity and no mortality among living donors when performed by experienced teams following strict procedures.
Highlights
The first reported case of acute liver failure (ALF) was described in 1946, the definition was introduced in 1970 by Trey and Davidson [1]
Our experience showed that it may be performed with very good results, and with very low morbidity and no mortality among living donors when performed by experienced teams following strict procedures
The outcome of liver transplantation (LT) for ALF is worse in children than in adults and especially worse when compared to the results of LT for chronic liver diseases; it is associated with high mortality [3, 4]
Summary
The first reported case of acute liver failure (ALF) was described in 1946, the definition was introduced in 1970 by Trey and Davidson [1]. ALF is usually defined as a clinical syndrome characterized by an abrupt onset of jaundice and hepatic encephalopathy within 8 weeks after first clinical symptoms, often in the absence of any liver disease [1]. This generally accepted definition does not fully apply to ALF in children. The survival of liver transplant recipients for ALF depends mainly on the urgent (hours or days) availability of a suitable donor This is difficult in pediatric patients as the possibility of harvesting a matching liver from a deceased donor (DD) is especially unpredictable
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