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

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

World J Transplant. 2023 Mar 18;13(3):96-106. doi: 10.5500/wjt.v13.i3.96.

Affiliations

¹ Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria 21615, Egypt.
² Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom.
³ Liver and Transplant Surgery, The Leeds Teaching Hospitals, NHS Foundation Trust, Leeds LS9 7TF, United Kingdom. abdul.hakeem1@nhs.net.

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 trans plantation (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 1^st year post-PLT in ALF group. Once the ALF children overcome the 1^st year after transplant, their survival stabilizes, and they have good long-term outcomes.

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