Published online Mar 18, 2023. doi: 10.5500/wjt.v13.i3.96
Peer-review started: December 2, 2022
First decision: December 13, 2022
Revised: December 22, 2022
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: March 18, 2023
Children with acute liver failure (ALF) who meet the criteria are eligible for super-urgent transplantation, whereas children with end-stage chronic liver disease (ESCLD) are usually transplanted electively. Pediatric liver trans
To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.
This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.
Over a 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years vs 5.4 years; P = 0.031) and heavier (31 kg vs 21 kg; P = 0.011). Living donor grafts were used more in the ESCLD group (34 vs 0; P = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was significantly higher in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4%, respectively, compared to 78.3%, 78.3%, and 78.3% in the ALF group (P = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival between the ESCLD and ALF groups (90.7%, 82.9%, 77.3% vs 75.6%, 72.4%, and 66.9%; P = 0.119).
Patient survival is inferior in ALF compared to ESCLD recipients; the main reason is death in the 1st year post-PLT in ALF group. Once the ALF children overcome the 1st year after transplant, their survival stabilizes, and they have good long-term outcomes.
Core Tip: To the best of our knowledge, this is the first study to compare the complications and survival outcomes in acute liver failure (ALF) and end-stage chronic liver disease (ESCLD) children post-pediatric liver transplantation (PLT). This study not only showed that survival in the ALF group was significantly inferior post-PLT but also showed a different pattern of survival where ALF survival was mostly affected in the 1st year post-transplant and then stabilized, whereas ESCLD survival declined steadily over time.