Is age less than 1 year a high-risk category for orthotopic liver transplantation?

• Published in: Journal of pediatric surgery Vol. 28; no. 8; pp. 1048 - 1050
• Main Authors: Dunn, Stephen P., Weintraub, William, Vinocur, Charles D., Billmire, Deborah F., Falkenstein, Kathleen
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.08.1993; Elsevier
• Subjects: Biliary Atresia - mortality; Biliary Atresia - surgery; Biological and medical sciences; Child; Child, Preschool; Female; Gastroenterology. Liver. Pancreas. Abdomen; Graft Rejection - mortality; Graft Rejection - surgery; Humans; Infant; Liver Transplantation - mortality; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Malformations; Medical sciences; Postoperative Complications - mortality; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Risk Factors; Survival Rate; Orthotopic liver transplantation, infants; biliary atresia; Human; Biliary tract; Surgery; Atresia; Digestive diseases; Complication; Infant; Risk; Transplantation; Biliary tract disease; Homotransplantation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/0022-3468(93)90516-N

The aim of this study was to determine if age less than 1 year is a high risk group for orthotopic liver transplantation (OLT). Retrospective analysis was done of patients with liver failure who received OLT. Comparison was made between patients aged <1 year and >1 year with regard to survival, allograft survival, hepatic artery thrombosis, and medical status at OLT. Between January 1, 1987 and September 30, 1991, 46 children received OLT. Fifteen (35%) were <1 year (average age, 7.93 months). Survival in children <1 year was 80% and children >1 year was 91%. Allograft survival in children <1 year was 57% (21 allografts required for 12 survivors) and 78% in children >1 year (37 allografts required for 29 survivors). Retransplantation was required in 5 of 15 children <1 year (33%) and in 5 of 29 children (17%) >1 year. Medical status in children <1 year was similar to medical status in children >1 year at the time of transplant. Children with chronic stable liver disease represented 60% of children <1 year and 60.1% of children >1 year. Children requiring hospitalization represented 26% of children <1 year and 29% of children >1 year. Children in intensive care represented 13% of children <1 year and 11% of children >1 year. Survival for all status groups was similar. Hepatic artery thrombosis occurred in one child <1 year and in 2 children >1 year. No statistical difference ( χ 2 analysis) was found by age between the categories evaluated. Previous reports indicate a survival in children <1 year of age after OLT that has been significantly less than that for older children. Although children <1 year of age present extreme challenges, our experience suggests that they are not a high-risk group for OLT. These children may suffer if high-risk designation causes a delay in OLT until they are no longer stable or have died of liver disease.