Long Term Outcomes of Pediatric Liver Transplantation According to Age

Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). The survival outcome of pediatric LT is excellent and similar regardless of age. LTs in infancy are not riskier than those of children. Graphical Abstract Keywords: Pediatrics, Liver Transplantation, Survival Rate, Fulminant Hepatitis, Living Donors, Liver Transplantation INTRODUCTION Liver transplantation (LT) has been a key therapy for end stage liver diseases in children for over 40 yr. In 1988, a successful deceased donor whole LT was performed for the first time in Korea at the Seoul National University Hospital on a 14-yr old girl who was suffering from Wilson's disease (1). Last year, we performed a total of 1,000 cases of LT including 700 cases of living donor LT (LDLT). The recent outcome of LT in our institution was improved according to the experience of the centers' practitioners (2). Several large scale studies for the outcome of pediatric LT have been published in other countries (2-6). For these studies, the disease categories and outcome of LT as well as the physiologic changes of the children significantly differed according to the age at the time of the transplant. Children < 12 months have been known to have a higher risk than older children. Several data have been analyzed on prognostic factors of pediatric LT according to the different age groups. However, these were based on deceased donor liver transplantation (DDLT). The aim of this study was to evaluate survival outcomes of the pediatric LTs according to different age groups, and to reveal the associated prognostic factors.