Outcome of liver transplantation in children under 10kg: Experience at a single Italian Tertiary Center (University of Padova, 1993–2012) and review of the literature

Abstract

Background: Infants (<1 year) and small children (<10 kg) represent more than a third of pediatric liver transplant (LT) recipients. It is commonly assumed that young age and low body weight are associated with increased morbidity and mortality after LT.Objective: To evaluate the outcome of LT, in terms of patient and graft survival, in pediatric recipients < 10 kg.Methods: 1. All children with a body weight under 10 kg transplanted at our Institution between January 1993 and May 2012 were retrospectively evaluated. 2. A systematic literature search was conducted through MEDLINE/PUBMED to retrieve all studies, published from January 2000 to September 2012, investigating LT outcomes in children under 10 kg.Results: 1. 30 patients with a median weight of 8.4 kg (4.4-–10) and a median age of 1 year (0.1–3.6) were included in the analysis. All children received cadaveric grafts, of which 66.6% were split livers. Median follow up time per patient was 5.7 years. Overall patient and graft survival were 96.7% and 84.5% respectively. Median re-transplantation and re-operation rates were 13% and 40%. 2. 17 articles, were retrieved. Overall patient survival ranged from 60% to 97%, while graft survival from 56% to 93%. Median re-transplantation and re-operation rates were respectively 7% and 35%.Conclusions: Although technically demanding, LT can be performed in children under 10 kg with excellent patient and graft survival. Post-transplant complication rates are still high in this group of children; thus, further improvements are needed to reduce patient morbidity after transplant. Background: Infants (<1 year) and small children (<10 kg) represent more than a third of pediatric liver transplant (LT) recipients. It is commonly assumed that young age and low body weight are associated with increased morbidity and mortality after LT. Objective: To evaluate the outcome of LT, in terms of patient and graft survival, in pediatric recipients < 10 kg. Methods: 1. All children with a body weight under 10 kg transplanted at our Institution between January 1993 and May 2012 were retrospectively evaluated. 2. A systematic literature search was conducted through MEDLINE/PUBMED to retrieve all studies, published from January 2000 to September 2012, investigating LT outcomes in children under 10 kg. Results: 1. 30 patients with a median weight of 8.4 kg (4.4-–10) and a median age of 1 year (0.1–3.6) were included in the analysis. All children received cadaveric grafts, of which 66.6% were split livers. Median follow up time per patient was 5.7 years. Overall patient and graft survival were 96.7% and 84.5% respectively. Median re-transplantation and re-operation rates were 13% and 40%. 2. 17 articles, were retrieved. Overall patient survival ranged from 60% to 97%, while graft survival from 56% to 93%. Median re-transplantation and re-operation rates were respectively 7% and 35%. Conclusions: Although technically demanding, LT can be performed in children under 10 kg with excellent patient and graft survival. Post-transplant complication rates are still high in this group of children; thus, further improvements are needed to reduce patient morbidity after transplant.