Liver Transplantation during Infancy Provides Similar Overall Results and Might Enhance Prope/Operational Tolerance in the Long Term

In our recent liver transplant (LT) experience, as much as 38% of patients were transplanted during infancy ( 1 yr post-LT), with a documented median follow-up of 6.0 yrs. In these, prope tolerance was defi ned as tacrolimus monotherapy, with mean trough blood levels 4ng/ml during the preceding year, combined with normal liver tests; operational tolerance was defi ned as stable immunosuppression withdrawal (>1yr). Results: Among the 75 children transplanted as infants, the 1- and 5-yr patient survival rates were 97% and 93%, versus 93% and 92% for children transplanted beyond 1 year of age, respectively (NS); the corresponding graft survival rates were 95% and 90%, versus 88% and 84% (NS). At 5 yrs, no signifi cant difference was observed in term of hepatic artery thrombosis rate ( 1yr: 4%, NS) or biliary complication rate ( 1yr: 22%, NS). Only the 5-yr rate of portal vein complication was signifi cantly higher in infants ( 1yr: 4%, p=0.01). Regarding the immunological issues, the 5 yr rate of acute rejection was comparable in both groups ( 1yr: 61%, NS); similarly, no difference was found for chronic rejection ( 1yr: 4%, NS). Among the 168 long-term survivors post-LT, 38/68 recipients transplanted as infants became prope/operationally tolerant (56%), compared to 41/100 children transplanted beyond 1 yr of age (41%) (p=0.058). Moreover, steroid avoidance and living related LT were both signifi cantly associated with later occurrence of a prope/operational tolerance (p=0.011 and p=0.01, respectively). Conclusions: (1) No signifi cant impact of recipient age on overall patient/ graft outcome could be evidenced; (2) transplanted infants seemed to have increased rate of portal complications, possibly related to portal vein hypoplasia; (3) despite similar rejection rates, infants showed a trend toward enhanced allograft tolerance in the long-term.