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Outcome of 200 pediatric living donor liver transplantations in India

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Abstract

Objective

To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years.

Materials and Methods

A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome.

Results

Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease.

Conclusions

Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Hepatology and Liver transplant, Medanta–The Medicity, Gurgaon, Haryana, India

    Neelam Mohan, Sakshi Karkra & Deepak Goyal

  2. Pediatric Intensive Care Unit, Medanta–The Medicity, Gurgaon, Haryana, India

    Maninder S. Dhaliwal & Veena Raghunathan

  3. Institute of Liver Transplant and Regenerative Medicine, Medanta–The Medicity, Gurgaon, Haryana, India

    Amit Rastogi, Sanjay Goja, Prashant Bhangui, Vijay Vohra, Dheeraj Gautam & A. S. Soin

  4. Department of Radiology, Medanta–The Medicity, Gurgaon, Haryana, India

    Tarun Piplani, Vivek Sharma & S. S. Baijal

Authors
  1. Neelam Mohan
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  2. Sakshi Karkra
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  3. Amit Rastogi
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  4. Maninder S. Dhaliwal
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  5. Veena Raghunathan
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  6. Deepak Goyal
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  7. Sanjay Goja
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  8. Prashant Bhangui
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  9. Vijay Vohra
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  10. Tarun Piplani
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  11. Vivek Sharma
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  12. Dheeraj Gautam
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  13. S. S. Baijal
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  14. A. S. Soin
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Corresponding author

Correspondence to Neelam Mohan.

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Mohan, N., Karkra, S., Rastogi, A. et al. Outcome of 200 pediatric living donor liver transplantations in India. Indian Pediatr 54, 913–918 (2017). https://doi.org/10.1007/s13312-017-1181-4

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  • DOI: https://doi.org/10.1007/s13312-017-1181-4

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