INFANT PEDIATRIC LIVER-TRANSPLANTATION RESULTS EQUAL THOSE FOR OLDER PEDIATRIC-PATIENTS

Methods: From July 1984 to July 1995, 99 pediatric patients underwent 127 orthotopic liver transplants (OLT) at the University of Wisconsin Children's Hospital. The patients were divided into four groups accord ing to age at time of transplant: group I, 0 to 6 months (n = 20); gro up II, 6 to 12 months (n = 18); group III, 1 to 2 years (n = 10); and group IV, 2 to 18 years (n = 51). A retrospective analysis was per for med to compare these four groups with regard to preoperative indicatio ns and demographics, intraoperative technique, complications, and surv ival. All patients were followed up for 2 to 13 years. Results: Biliar y atresia was the most common indication for OLT in all four groups. T he average waiting period varied from 19 +/- 18 days for group I to 44 +/- 64 days for group IV. Reduced-size liver transplant (1, 41%; II, 52%; III, 28%; IV, 21%), split-liver transplant (I, 0%; II, 7.4%; III, 17%; IV, 2.9%), or whole-liver transplant techniques were used. Altho ugh postoperative Intensive Care Unit stay was longer for the 0- to 6- month-old patients (I, 20 +/- 64; II, 7.6 +/- 9; III, 13 +/- 17; IV, 6 .8 +/- 14 days), the total hospital stay (I, 43 +/- 63; II, 33 +/- 34; III, 32 +/- 20; IV, 29 +/- 31 days) was similar for all patients. The incidence of hepatic artery thrombosis (I, 19%; II, 19%; III, 27%; IV , 16%), biliary tract complications (I, 4.8%; II, 15%; III, 20%; IV, 1 4%), and retransplantation (I, 9.5%; II, 41%; III, 33%; IV, 14%) were not significantly different between the four groups. Portal vein throm bosis (I, 9.5%; II, 11%; III, 6.6; IV, 0%) and primary nonfunction (I, 9.5%; II, 7.4%; III, 0%; IV, 3.1%) occurred more frequently in the 0- to 6-month and 6- to 12-month groups, however, the 1; 5-, and 10-year survival rate for patients (I, 85%, 79%, 79%; II, 89%, 74%, 74%; III, 80%, 80%, 80%; IV, 84%, 75%, 75%, respectively) and primary liver all ografts (I, 69%, 69%, 69%; II, 72%, 72%, 63%; III, 70%, 70%, 70%; IV, 71%, 57%, 57%, respectively) were not significantly different (P =.98 and P =.83). Conclusion: These results demonstrate that OLT can be eff ectively performed on infants of all ages and that OLT should not be d elayed because of age. Copyright (C) 1998 by W.B. Saunders Company.