Over 30 Years of Pediatric Liver Transplantation at the Charité-Universitätsmedizin Berlin.

Simon Moosburner,Christian Witzel,Safak Gül-Klein,Stephan Henning,Tomasz Dziodzio,Johann Pratschke,Georg Lurje,Nathanael Raschzok,Moritz Schmelzle,Paul Ritschl,Robert Öllinger,Brigitta Globke,Wenzel Schöning,Alexander Gratopp,Philip Bufler,Leke Wiering

doi:10.3390/jcm11040900

Abstract

Background: Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center. Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité – Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991–2004, 2005–2014 and 2015–2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board. Results: Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12% (n = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days. Conclusion: The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.

Highlights

For pediatric patients with end-stage liver disease and certain hepatic malignancies, liver transplantation remains the treatment of choice [1,2]
Pediatric liver transplantation (LT) patients were defined according to the Eurotransplant Liver Allocation
Preoperative Model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) values, as well as postoperative laboratory parameters and length of hospital stay were available for all patients transplanted after

Summary

Introduction

For pediatric patients with end-stage liver disease and certain hepatic malignancies, liver transplantation remains the treatment of choice [1,2]. Surgical techniques for pediatric liver transplantation include full size orthotopic liver replacement, cadaveric split liver transplantation reduced size liver transplantation and, in rare cases, auxiliary liver transplantation, as well as living donor liver transplantation (LDLT) [7,8,9,10] The latter, even though technically challenging, has improved the treatment of children in need of liver transplantation dramatically as many organs from cadaveric donors, in an ageing donor population, are not eligible for pediatric liver transplantation. Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies.

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