Long-term Outcome of Liver Transplantation in Childhood

A Study of 20-Year Survivors

J. Martinelli; D. Habes; L. Majed; C. Guettier; E. Gonzalès; A. Linglart; C. Larue; V. Furlan; D. Pariente; C. Baujard; S. Branchereau; F. Gauthier; E. Jacquemin; O. Bernard

Disclosures

American Journal of Transplantation. 2018;18(7):1680-1689. 

In This Article

Abstract and Introduction

Abstract

We report the results of a study of survival, liver and kidney functions, and growth with a median follow–up of 24 years following liver transplantation in childhood. From 1988 to 1993, 128 children underwent deceased donor liver transplantation (median age: 2.5 years). Twenty–year patient and graft survival rates were 79% and 64%, respectively. Raised serum aminotransferase and/or γ–glutamyl transferase activities were present in 42% of survivors after a single transplantation. Graft histology (35 patients) showed signs of chronic rejection in 11 and biliary obstruction in 5. Mean total fibrosis scores were 4.5/9 and 3/9 in patients with abnormal and normal serum liver tests, respectively. Glomerular filtration rate was <90 mL·min−1 in 35 survivors, including 4 in end–stage renal disease who were undergoing dialysis or had undergone renal transplantation. Median final heights were 159 cm for women and 172 cm for men; final height was below the target height in 37 patients. Twenty–year survival after childhood liver transplantation may be close to 80%, and final height is within the normal range for most patients. However, chronic kidney disease or altered liver biochemistries are present in over one third of patients, which is a matter of concern for the future.

Introduction

Over the past 30 years, significant advances have been made in the pre–, intra–, and postoperative management of liver transplantation, which has become the treatment of choice for end–stage liver disease in children.[1] Many reports have described and analyzed patient and graft survival as well as results concerning growth, and liver and renal function in the short– (1 year) and medium– term (5–10 years). There have not been many reports, however, dealing with 20–year survivors. The available information either does not specifically consider in detail patients who underwent transplantation during childhood, or concentrates on the health–related quality of life.[2–4] The aim of this study is therefore to assess the survival, graft and renal function, and growth in a group of children with a median follow–up of 24 years after transplantation.

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