Doctors in Germany are touting the benefits of performing transplants for children with liver disease.1 Since beginning its liver transplant program in 1989, University Hospital Eppendorf at the University of Hamburg has seen "near perfect" patient survival, writes a group of hepatologists led by Dieter Broering, MD, in the department of Hepatobiliary Surgery at the hospital.
Transplant is the Standard Therapy Approach
In this country, liver transplantation is the standard of care for children with end-stage liver disease; that is, the point at which their liver can no longer effectively be treated with medication. Symptoms of end-stage liver disease include fatigue, jaundice, impaired blood clotting, muscle wasting, hepatic encephalopathy, and portal hypertension. It's estimated that each year, 800 children are placed on the liver transplant waiting list.2
When liver transplants are considered for children, there are several types that can be performed. Split-liver transplantation involves dividing a cadaver's liver while it is still in the donor's body with blood flowing to it. This is aimed at increasing the number of available livers since liver tissue can regrow. Living-related donor transplants involve a portion of an adult relative's liver that is transplanted to a child recipient. In reduced-liver transplant, surgeons take a portion of a cadaver's liver and place it in a child. These help compensate for dramatic differences in patient and donor weight. Finally, whole-liver transplants involve the removal of an entire, healthy donor liver. But the shortage of whole pediatric livers has forced doctors to develop more innovative methods of liver transplantation.2
In a paper published in the journal Annals of Surgery in December, Broering and his team analyzed the outcomes of pediatric liver transplant procedures performed at their institution between 2001 and 2003. In all, 132 liver transplants were performed for children during that time.
"Of 132 consecutive pediatric liver transplants, no patients died within the 6 months post-transplantation," Broering's group noted. During extended follow-up, 3 patients died, one due to severe pneumonia, and the second due to an unknown cause. Both had healthy livers at the time of death. The third patient had a recurrence of an unknown liver disease 9 months after undergoing transplantation.
The odds of survival of transplanted livers in these cases was 92% 3 months after surgery. Actual survival was 86%.
Transplant Setbacks
There were some cases in which complications arose. In 12 percent of the patients who had transplants during the 2-year period, retransplantation was necessary due to chronic liver rejection, liver non-function or poor function, and arterial thrombosis.
Other complications occurred rarely. Biliary complications occurred in 6% of cases, about 8-and-a-half percent of the patients had arterial problems, intestinal perforation was found in just 3 percent of the patients after surgery, and in 5 percent, postoperative bleeding required doctors to perform surgery a second time. Portal vein complications occurred in a very small proportion of patients.
"Progress during the past 15 years has enabled us to perform pediatric liver transplantation with near perfect patient survival," wrote Broering and his associates. This can be directly attributed to "advances in post-transplant care of the recipients, technical refinements, standardization of surgery and monitoring, and adequate choice of the donor organ and transplantation technique."
A Key 'Turning Point' in Pediatric Liver Disease
These outcomes mark a significant "turning point" in pediatric liver transplant outcomes, the doctors point out. We are nearing the day at which immediate survival after liver transplant "will be considered the norm."
1. Broering DC, Kim JS, Mueller T et al. One hundred thirty-two consecutive pediatric liver transplants without hospital mortality: lessons learned and outlook for the future. Ann Surg 2004 Dec;240(6):1002-12.
2. Types of Liver Transplant. Texas Children's Hospital. Available at: http://www.texaschildrenshospital.org/Parents/TipsArticles/ArticleDisplay.aspx?aid=773. Accessed January 5, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
