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523 PEDIATRIC LIVER TRANSPLANTATION IN THE MODERN ERA: LESSONS FROM A SINGLE-CENTER EXPERIENCE.
  1. L. Haft-Candell,
  2. R. S. Venick,
  3. S. Gordon,
  4. S. V. McDiarmid,
  5. R. W. Busuttil,
  6. D. G. Farmer
  1. David Geffen School of Medicine at UCLA, Los Angeles, CA

Abstract

Objective To describe in detail the pediatric liver transplant experience at a single center during the most recent era, those performed between the years 2000 and 2005.

Background Orthotopic liver transplantation (OLT) has been an established method for treating acute and chronic liver disease in children since the 1980s. Over the last 20 years, each era has been marked by improvements in surgical technique, perioperative care, and immunosuppression, translating into improved recipient outcomes.

Methods 170 patients between the ages of 25 days and 18.6 years underwent OLT between January 2000 and May 2005. Using medical records and an institutional database, retrospective analysis was performed examining patient demographics, type and incidence of post-transplant complications, and patient and graft survival.

Results During this time period, 170 patients received 200 OLTs. One hundred thirty-five whole organ grafts, 58 split grafts, and 7 living related donor grafts were utilized. The mean and median ages at OLT were 5.6 and 2.1 years, respectively. The most common indications for transplant were acute liver failure (24%), biliary atresia (23%), and re-transplant for graft complications (22%). Patient survival rates at 1 and 5 years post-transplant were 86% and 78%, respectively; allograft survival rates at 1 and 5 years post-transplant were 75% and 71%, respectively. Hepatic artery thrombosis was the most common complication involving the graft; sepsis was the most common medical complication. Of note, no new cases of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder were diagnosed during this 5-year period, an observation attributable to use of an intense viral monitoring prophylaxis and empiric treatment protocol.

Conclusions Liver transplantation in the pediatric population is an established treatment for acute and chronic liver disease. Patient and graft survival have increased significantly in the modern era as compared to previously reported outcomes. Univariate and multivariate analyses of the risk factors impacting patient and graft survival are currently under way.

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