Liver transplantation (LT) is accepted as the standard therapy for end-stage liver disease. The current shortage of organ donors has led to use split grafts and living-related donors to provide timely liver transplants to these children. We report our experiences with pediatric LT during a 9 years period. From April 1999 to August 2008, 138 infants and children who underwent LT were studied retrospectively for pretransplantation status, medical and surgical complications and survival rate. There were 83 (60.1%) boys and 55 (39.9%) girls. The mean age of patients was 9.1±5.6 yr (range: 0.5-18) with a mean weight of 28.1±17.0 kg (range: 7-80). The main indications were Wilson disease (20.3%), cryptogenic cirrhosis (16.7%), and autoimmune cirrhosis (14.5%), followed by biliary atresia (13.8%), tyrosinemia (9.4%), and progressive familial intrahepatic cholestasis (8.7%). We used living-related donor in 54 (39.1%) and split liver in 20 (14.5%) cases and 64 (46.4%) patients received whole liver from deceased donors. The mean follow-up of patients was 25.3 ± 20.3 months (range: 1-100). The mortality rate was 27.5% (26.1% in-hospital mortality). The main causes of mortality were vascular complications (32.6%), primary nonfunction (19.6%), sepsis (17.4%), chronic rejection (17.4%), and biliary complications (6.5%). Mortality rate in patients under 10 kg (58.8%) was very higher than patients over 10 kg (23.1%). Among those patients who discharged from hospital (73.9%) the most common cause of mortality was chronic rejection from non-compliance (4 cases), chronic rejection (3 cases) and post transplant lymphoproliferative disease (2 cases). In conclusion, Our results demonstrate that pediatric LT is a feasible undertaking in Iran. Organ shortage in our area led to liberal use of living related and split liver techniques. The overall results of the pediatric LT in Iran are acceptable but we should use every effort to improve this.
Volume : 6
Issue : 4
Pages : 27
Shiraz Transplant Center, Namazi Hospital and Transplantation Research Center, Shiraz University of Medical Sciences, Shiraz, Iran