Late Re-transplantation of the Liver in Adulthood Following Successful Paediatric Transplantation'

Abstract

Introduction: The survival outcomes of paediatric liver transplantation (LT) have improved from 30% in the 1970's to over 90% in the current era. Therefore a huge number of paediatric LT recipients are reaching adulthood. Non-compliance, chronic rejection and vascular related complications are common reasons for late allograft failure after a successful paediatric LT. Methods: In this case series we specifically reviewed the outcomes of 11 patients who underwent a successful paediatric LT and underwent re-transplantation as an adult, due to primary graft failure at Queen Elizabeth Hospital Birmingham, UK. Results: The mean age at the time of primary LT was 7.3 (+6.2) years and the most common indication was biliary atresia (36.4%). Chronic rejection was the most common reason for primary graft failure (77%) followed by hepatic artery thrombosis. The mean graft survival after paediatric LT was 13.1 (± 4.4) years. Re-transplantation of liver as adults was performed at a mean age of 23.3 (+4.2) years. Vascular related complications were observed in 36% of patients and overall postoperative morbidity rate was 88.9%. After re-transplantation the median graft survival was 34 months (2-91 months). There was only 1 ninety-day mortality. One, three and five year survival rates were 82%, 73% and 73% respectively. A third transplant was needed in 18% of patients. Conclusion: Re-transplantation of liver in paediatric patients as adults is technically very challenging. High morbidity and mortality rates are not unexpected as these patients are already immunosuppressed and undergoing a very complex vascular and biliary reconstruction.