P0240 LIVER TRANSPLANTATION IN CROATIA

Abstract

Introduction: Pediatric liver transplantation programme has been started in Croatia since September 2001. There are many issues which are not in favour of such a programme in small country with low frequency of expected cases, lack of donor network and everlasting problems with funding. Methods: The charts of all patients who received liver transplantation to study complications of transplant surgery, immunosupression and overall survival rate were reviewed retrospectively Results: Between September 2001 and November 2003 8 children underwent liver transplantation (3 living-related and 5 cadaveric grafts). Patients were between the ages of 9 months and 14 years of age (mean 7,06 yrs). Three patients received reduced left lateral segmental (II and III segment) living-related transplants. Five received cadeveric allografts (four reduced-size and one whole liver graft). Indications for transplantation included biliary atresia (n=3), alpha-1-antitrypsin deficiency(n=1), PFIC type I (n=1), Crigler-Najjar type I (n=1), choledochal cyst(n=1) and cryptogenic cirrhosis. All patients received primary tacrolimus immunosuppressive regimen. sixty-two percent of patients experienced at least 1 episode of rejection. Immidiate postoperative complications included primary nonfunction (n=1), vascular thrombosis (n=1), biliary leaks (n=4) and infections (n=9). One patient required retransplantation due to secondary vascular thrombosis and multiple fungal abscesses. She died during re-transplantation 3.5 months after first transplantation. There was one early death due to primary nonfunction. Six patients (75%) are alive at 1.5 month to 27 months post-transplant. Conclusion: Living transplantation is an effective intervention for pediatric end-stage liver disease even in small countries despite all drawbacks.