Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2023; 13(3): 96-106
Published online Mar 18, 2023. doi: 10.5500/wjt.v13.i3.96
Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study
Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia
Amr M Alnagar, Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria 21615, Egypt
Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia, Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom
Author contributions: Alnagar AM and Hakeem AR contributed equally to this study; Alnagar AM and Attia MS conceived the study concept and design; Alnagar AM and Daradka K collected the data; Alnagar AM, Kyrana E, Methga M, and Palaniswamy K analyzed the data; Rajwal S, Mulla J, Upasani V, and Vijayanand D drafted the manuscript; Hakeem AR, Prasad R, O’meara M, and Attia MS critically revised the manuscript.
Institutional review board statement: Regarding institutional board acceptence, that was not required in view of the retrospective nature of the study for an already collected data without any patient identifiable data.
Informed consent statement: Informed consent is not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at abdul.hakeem1@nhs.net. Participants' consent was not obtained but the presented data are anonymized, and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdul R Hakeem, FRCS, PhD, FEBS, Consultant Hepatobiliary and Liver Transplant Surgeon, Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds City Centre-Beckett Street, Leeds LS9 7TF, United Kingdom. abdul.hakeem1@nhs.net
Received: December 2, 2022
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
Abstract
BACKGROUND

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 transplantation (PLT) in ALF and ESCLD settings has been well described in the literature, but there are no studies comparing the outcomes in these two groups.

AIM

To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Pediatric liver transplantation, Acute liver failure, End-stage chronic liver disease, Graft failure, Patient survival, Complications

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.