Pediatric Liver Transplantation: A Preliminary Report of KFSH&RC Organ Transplant Center Experience

Background : Liver transplantation is a well-established modality of treatment for various end stage liver diseases and several metabolic diseases in children. At KFSH & RC, pediatric liver transplantation has been conducted for over a decade. However over the last two years, there has been a surge on the number of LT procedures conducted annually. Aim: To evaluate our recently established Organ Transplant Center experience in pediatric liver transplantation and report our preliminary results. Material & Method : Chart review of 68 patients who received 71 liver transplants during the period of November 2010 - December 2012. Results : 68 patients aged 4 months-16 years (Median 19 months) underwent 71 transplant procedures. Weight at transplantation was 4.72-32.5 Kg (Median 8.86 Kg). Transplanted grafts where from a living donor 94 % (n=67, 4 are ABO incompatible) and from cadaveric split and whole organ (n=4). Biliary atresia was the commonest indication in 31 % (n=22), Familial cholestatic syndromes in 24 % (n=17), Metabolic liver disease 12.7% (n=9). Biopsy proven acute cellular rejection developed in 19.7 % (n=14), 2 patients had chronic rejection and 1 had De novo AIH. Vascular complications developed in 8.4 %. Hepatic artery thrombosis (HAT) developed in 2 patients, portal vein thrombosis (PVT) in 3, one patient had portal vein stenosis (PVS). Biliary complications developed in 4 %, one patient had a biliary leak, while two recipients developed biliary strictures. Other surgical complications developed in 8.4 %, 3 patients had intestinal perforation, two developed diaphragmatic hernia and one patient had compartment syndrome. 4 deceased (3 at home) due to graft unrelated causes. One year patient and graft 1year survival for (2010-2011) are 97.1%. Actuarial graft and patient's survival for (2010-2012) are 90.1 % and 94 % respectively. Conclusion : Our biopsy proven rejection, vascular, biliary and other surgical complications rates are below internationally published rates. Extended genetic/metabolic work up is needed for undiagnosed cholestatic and cirrhotic liver diseases. Significant number of non-survivals deceased at home that call for improving family - hospital communications. Despite the obstacles associated with establishing a new program in a developing country, we have overcome a steep learning curve with outcome results comparable to internationally published series.