Liver transplantation in infants and children. Evaluation of the first 40 cases (March 1991-March 1997)

Background. - Liver transplantation (LT) is the treatment of end-stage live r disease in children. We report our experience with LT using grafts from l iving related (LRD) and cadaver donors (CD). Population. - From March 1991 to March 1997, 40 children and infants receiv ed a total of 42 liver grafts. A reduced-size liver was used in 28 cases. W e studied pre-transplantation status, survival rate, and medical and surgic al complications in these patients. Results. - The survival rate in our series was respectively 85 and 80% at 1 and 7 years after LT. Low weight infants required a prolonged ventilatory assistance. Five of the six deaths noticed during the first three months af ter LT occurred in children weighing less than 12 kg. One year after LT; no significant difference in the incidence of rejection was found, neither be tween low-weight children and the others, nor between patients transplanted from CD or LRD. Biliary tract stricture was the major surgical complicatio n. Conclusion. - This series consisted of a majority of low-weight children. T he survival rate in the patients weighting less than 12 kg is lower than in the others. This may be explained by the nutritional status of these patie nts and early postsurgical complications. The use of grafts from living don ors offers more flexibility since the operation is performed electively but ii did not seem to modify the incidence of acute rejections and surgical c omplications. (C) 2000 Editions scientifiques et medicales Elsevier SAS.