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Living donor liver transplantation successful in young infants

Living donor liver transplantation during the first 3 months of life had excellent patient and graft survival, according to results of a single-center study.

“Although the indications for LT in young infants (including dominant fulminant hepatic failure, hemochromatosis, metabolic disease, etc.) are limited and differ from those in older infants, the rates of morbidity and mortality are considered to be high in comparison to older children because of the technical difficulty and their immunological immaturity,” Mureo Kasahara, MD, PhD, and colleagues wrote. “[Living donor] LT might deliver fewer adverse outcomes than deceased donor LT, especially in this population.”

Between November 2005 and November 2016, 436 children underwent LT at the National Center for Child Health and Development, Tokyo. Twelve of these patients with end-stage liver disease were younger than 3 months.

This cohort included 9 girl and 3 boy patients with a median age of 41 days (range, 29-90 days), median weight of 4 kg (range, 2.4-5.5 kg) and a mean PELD score of 33 (range, 12-52). Eleven of the twelve required transplantation for fulminant hepatic failure and one for ornithine transcarbamylase deficiency.

The 10-year patient and graft survival rates in the cohort were both 90.9%. The most common complications were blood stream, cytomegalo virus and Epstein-Barr virus
infections, and two patients had biliary complications. One patient died from respiratory failure due to respiratory syncytial virus, though lung function was normal at the time of death.

The researchers compared the results of this living donor LT (LDLT) cohort to LDLT patients aged 4-6 months (n = 67) and 7 to 12 months (n = 110) in the same study period. The study cohort of patients younger than 3 months had higher PELD scores and tended to have a higher incidence of fulminant hepatic failure. There was also a significant difference in the rate of conversion from tacrolimus to cyclosporine in the study cohort.

The 10-year patient and graft survival rates for the 4 to 6 month cohort and 7 to 12 month cohort were 92.5%/90.9% and 91.7%/82.6%, respectively.

“The disadvantages with the use of relatively large-for-size grafts include insufficient tissue oxygenation and graft compression, which results in a poor outcome,” the researchers wrote. “Because small-sized grafts are difficult to obtain in deceased donor whole graft LT, LDLT with reduced [left lateral segment] grafts may play a role as an alternative treatment in these young infants.”

The researchers believe that LDLT is a feasible option for patients than younger than 3 months and advise that long-term observation and additional studies may be necessary to collect sufficient data to establish this treatment modality. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.