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Live donor liver transplantation for pediatric acute liver failure: challenges and outcomes

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Abstract

Objective

This study aimed at studying the challenges and outcomes of live-donor liver transplantation (LDLT) for pediatric acute liver failure (PALF).

Study design

A total of 315 patients with PALF were treated over a period of 11 years. 42 underwent LT (41 LDLT and one DDLT), constituting 38% (41/110) of all pediatric transplants during this duration. The outcomes of LDLT for PALF were analyzed.

Results

All the 41 children who underwent LT met the Kings College criteria (KCC). The etiology was indeterminate in 46.3% (n = 19) children. 75.6% (n = 31) were on mechanical ventilation for grade 3/4 hepatic encephalopathy. There was presence of cerebral edema on a computed tomography scan of the brain in 50% of the children. One-third of our children required hemodynamic support with vasopressors. Systemic inflammatory response syndrome and sepsis were observed in 46.3% and 41.4% of patients, respectively. Post-LDLT 1- and 5-yr patient and graft survival were 75.6% and 70.9%, respectively. The survival in children satisfying KCC but did not undergo LT was 24% (38/161). Vascular and biliary complication rates were 2.4% and 4.8%, respectively. No graft loss occurred because of acute rejection. In multivariate analysis, pre-LT culture positivity and cerebral edema, persistence of brain edema after transplantation, and resultant pulmonary complications were significantly associated with post-LT death. Thirteen (32%) children who underwent plasmapheresis prior to LT had better post-LT neurological recovery, as evidenced by early extubation.

Conclusion

LDLT for PALF is lifesaving and provides a unique opportunity to time transplantation. Good long-term survival can be achieved, despite the majority of patients presenting late for transplantation. Early referral and better selection can save more lives through timely transplantation.

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Data availability

The data supporting the findings of the present study are available within the article.

Abbreviations

ALF:

Acute liver failure

ACR:

Acute cellular rejection

CMV:

Cytomegalovirus

DDLT:

Deceased donor liver transplantation

HAV:

Hepatitis A virus

HAT:

Hepatic artery thrombosis

INR:

International normalized ratio

ICU:

Intensive care unit

KCC:

King’s college criteria

SIRS:

Systemic inflammatory response syndrome

LT:

Liver transplantation

LDLT:

Liver donor liver transplantation

ATT:

Anti-tubercular treatment

MMF:

Mycophenolate mofetil

PALF:

Pediatric acute liver failure

POD:

Postoperative day

HVPE:

High volume plasma exchange

PCD:

Percutaneous drain

HE:

Hepatic encephalopathy

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Acknowledgements

Authors wish to thank senior statistician Dr. Guresh Kumar for his support with statistical analysis.

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Authors and Affiliations

  1. Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India

    Viniyendra Pamecha, Nilesh Sadashiv Patil, Sanyam Falari, Nihar Mohapatra & Anubhav Harshit Kumar

  2. Department of Anesthesiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India

    Gaurav Sindwani & Neha Garg

  3. Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India

    Seema Alam, Rajeev Khanna, Vikrant Sood & Bikrant Bihari Lal

Authors
  1. Viniyendra Pamecha
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  2. Nilesh Sadashiv Patil
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  3. Sanyam Falari
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  4. Nihar Mohapatra
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  5. Anubhav Harshit Kumar
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  6. Gaurav Sindwani
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  7. Neha Garg
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  8. Seema Alam
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  9. Rajeev Khanna
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  10. Vikrant Sood
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  11. Bikrant Bihari Lal
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Contributions

Study concept: VP. Study design: VP, NP. Data collection: SF, AHK, NP, NM, SA, RK, GS, VS, BBL, GS, NG. Analysis and interpretation of data: NP, SF, VP. Manuscript drafting: NP, VP. Critical revision of the manuscript for important intellectual content: VP and NP.

Corresponding author

Correspondence to Viniyendra Pamecha.

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Conflict of interest

The authors Viniyendra Pamecha, Nilesh Sadashiv Patil, Nihar Mohapatra, Sanyam Falari, Anubhav Harshit Kumar, Gaurav Sindwani, Neha Garg, Seema Alam, Rajeev Khanna, Vikrant Sood, and Bikrant Bihari Lal have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the Institutional Ethics Committee (no. IEC/2020/80/MA03) and was conducted in accordance with the ‘Declaration of Helsinki (2013) and Istanbul (2018)’for medical research involving human subjects.

Consent to participate

As this study did not involve any intervention, consent was not obtained from the study population.

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All authors have read the final version of the article and have provided consent for the article to be published in “Hepatology International”.

Animal research

No animal research was done.

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Pamecha, V., Patil, N.S., Falari, S. et al. Live donor liver transplantation for pediatric acute liver failure: challenges and outcomes. Hepatol Int 17, 1570–1586 (2023). https://doi.org/10.1007/s12072-023-10571-4

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