Various immunologic, metabolic, and technical factors render pediatric recipients with end-stage renal or liver diseases unique from their adult counterparts. In addition, the potential for complications after renal or liver transplants are far greater in children than it is in adults. In this study, we retrospectively analyzed the clinical features of our pediatric recipients who had undergone a kidney or a liver transplant at our institution since 1985. Since that time, 1385 renal transplants were done at our institution. Of these, 124 procedures were performed on 122 pediatric patients (67 male and 57 female patients; mean age: 14.9 ± 2.2 years; range: 4-17 years). Grafts had been obtained from a deceased donor in 31 cases. Two patients (1.6%) underwent a retransplant at 4 and 2 years after the initial operation. Eight grafts failed, and 7 recipients died with a functioning graft during the follow-up. The 1- 3-, 5-year patient and graft survival rates were 98%, 93%, and 92%, and 91%, 78%, and 67%, for living-related transplants compared with 98%, 91%, and 90%, and 92%, 76%, and 65% for deceased donor transplants, respectively. Since September 2001, of the 239 liver transplants, 7 deceased-donor and 97 living-donor liver transplants had been performed on 101 children (mean age, 6.7 ± 5.5 years; range 2 months to17 years). Main indications for liver transplant were cholestatic liver disease, biliary atresia, Wilson disease, fulminant liver failure and tumors. The median pediatric end-stage liver disease score was 23.1 ± 11.1 (range, -8 to 48). The median follow-up was 24.2 ± 19.4 months (range, 1-77 months). Three children underwent retransplant. The main complications were infections (31.3%) and surgical complications (39.5%) (Including biliary complications and vascular problems). Sixteen children died during follow-up, and, at the time of this writing, the remaining 85 children (85%) were alive with good graft functioning, showing patient survival rates of 90%, 85%, and 83% at 6, 12, and 36 months, respectively. In conclusion, better outcomes for renal and liver transplants in children may be obtained by strict adherence to precise surgical techniques, better immunosuppressive management, and early diagnosis and effective treatment of complications.
Volume : 6
Issue : 4
Pages : 36
Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey