Recent developments in surgical technique, immunosuppression and patient selection criteria improve long term patient and graft survivals of pediatric liver transplantation patients. In this study, the results of the last 21 consecutive pediatric recipients, whom were underwent liver transplantation between January 2003 to July 2004 were investigated. Cholestatic diseases (n=9, 43%) (4 biliary atresia, 2 Byler’s disease, 1 bile duct paucity, 1 progressive familial intrahepatic cholestasis and 1 Allagille’s syndrome) and Wilson’s disease (n=7, 33%) were the most common indications for liver transplantation in our patients. Other indications were fulminant hepatic failure in 4 (3 viral, 1 mushroom poisoning) and cryptogenic hepatitis in 1 patient. One child with Byler’s disease also had occult hepatocellular carcinoma, diagnosed in the hepatectomy specimen. Only 1 patient had the chance of getting a cadaveric whole liver transplantation, remaining 20 children (95.2%) underwent living related liver transplantations. In 13 operations left lobes, in 5 right lobes and in 2 left lateral segments of the donor livers were used. All recipients received low dose tacrolimus and steroid based immunosuppressive medications. One or more biopsy proven acute rejection episodes were observed in 5 of the recipients. All rejections responded steroid pulse treatment except one, who had treated with 14 days of OKT3 treatment. No grafts were lost due to rejection during the follow-up period.
In 3 of the recipients serious viral infections, 2 Ebstein-Barr and 1 Cytomegalovirus, were observed and 2 of them died with septicemia, although the appropriate antiviral treatments had been given. As vascular complications, in 1 recipient (5%), hepatic arterial thrombosis was diagnosed with a routine daily Doppler ultrasonography before liver enzymes were elevated, and treated with operative thrombectomy and re-anastomosis. Two hepatic arterial stenosis were treated non-operatively with successful balloon dilatation and stents.
In 8 of the patients (38.1%) biliary complications developed, 3 of them were anastomotic leaks, 2 were minor bile leaks from the graft’s cut surface and 2 were minor bile leaks from the biliary stents insertion points. In 1 patient, a bile leakage was occurred after removal of the T-tube. None of the biliary complications had required re-operations and all were treated with percutaneous interventions. No grafts were lost due to vascular or biliary complications. Three of the patients died during the follow-up period with a mortality rate of 14.3%, with uncontrolled septicemia in 2 and ARDS in 1. Overall patient and graft survival rates were 85.7% in our pediatric liver recipients. Although, there are difficulties in pediatric liver transplantations due to serious cadaveric organ shortage and small sized vascular and biliary structures, satisfactory long term results can be obtained with living related donors by meticulous surgical technique and prompt interventions for possible complications.