Complications and mortality in cirrhotic children awaiting liver allografts: a single-center report from Iran

Abstract

Liver transplantation (LT) is the treatment of choice for end-stage liver disease in children, but donor shortage is still a central problem in this age group. Objective. To evaluate the rate of complications and mortality in cirrhotic children awaiting transplantation. Patients and methods. We analyzed medical records of 113 children under 18 years of age who were listed for LT, but the organ was unavailable between 2013 and 2018. The outcome was assessed from their records or follow-up data. Results. Among the children (mean age: 3.79 years; 50.4% boys and 49.6% girls) awaiting LT, the common causes of cirrhosis were biliary atresia (38.9%) and progressive familial intrahepatic cholestasis (17.7%). While awaiting transplantation, 82 (72.6%) children died. The most common complications were encephalopathy (34.5%), esophageal bleeding (26.5%), infections (23.0%), and spontaneous bacterial peritonitis (13.3%). The mean duration of hospital admission was 2.72 ± 3.10 days. Conclusion. About two-thirds of children listed for LT developed complications, and about three-quarters died without any LT. It seems that split liver transplantation and the introduction of a live-related transplant program in our center will provide many benefits to pediatric patients. Key words: liver transplantation, mortality, cirrhosis, pediatrics, children