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  • Title: Liver transplantation in children younger than 1 year--the Cincinnati experience.
    Author: Tiao GM, Alonso M, Bezerra J, Yazigi N, Heubi J, Balistreri W, Bucuvalas J, Ryckman F.
    Journal: J Pediatr Surg; 2005 Jan; 40(1):268-73. PubMed ID: 15868596.
    Abstract:
    BACKGROUND/PURPOSE: The success of pediatric orthotopic liver transplantation (OLTxp) has improved greatly since its widespread application in the 1980s. No group has benefited more from this than infants younger than 1 year. The authors reviewed their experience in the management and outcome of children who underwent OLTxp when they were younger than 1 year. METHODS: A retrospective review of the medical records of patients who at the time of OLTxp were younger than 1 year was performed. Patients were stratified according to the period when transplanted. RESULTS: Eighty-one infants younger than 1 year underwent OLTxp. End-stage liver disease secondary to biliary atresia was the most common indication for transplantation. The overall survival was 77%. One-year patient and graft survival improved from 58% and 50% in the period 1986-1989, respectively, to 88% and 81% in the period 2000-2003, respectively. Technical complications such as hepatic artery thrombosis (n = 5) and portal vein thrombosis (n = 8) occurred, and although 4 patients required retransplantation, all but one survived. Complications associated with immunosuppression, sepsis/multisystem organ failure (MSOF) (n = 11), and posttransplant lymphoproliferative disease (PTLD) (n = 1) were the most common cause of poor outcome. CONCLUSIONS: Successful OLTxp in infants is possible with improved posttransplant survival during the study period. Technical complications (hepatic artery thrombosis/portal vein thrombosis) may require retransplantation but were uncommon causes of patient loss. Multisystem organ failure was the most significant adverse complication. The consequences of immunosuppression (MSOF/PTLD) were the most common cause of patient loss. Further improvement in overall survival will require better immunosuppressive strategies.
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