Abstract
Background. End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT). Methods. Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8). Results. Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively. Conclusions. SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.
| Original language | English |
|---|---|
| Pages (from-to) | 1197-1203 |
| Number of pages | 7 |
| Journal | Transplantation |
| Volume | 75 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Apr 27 2003 |
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ASJC Scopus subject areas
- Transplantation
- Immunology
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Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease. / Gridelli, Bruno; Spada, Marco; Petz, Wanda; Bertani, Alessandro; Lucianetti, Alessandro; Colledan, Michele; Altobelli, Monica; Alberti, Daniele; Guizzetti, Michela; Riva, Silvia; Melzi, Maria L.; Stroppa, Paola; Torre, Giuliano.
In: Transplantation, Vol. 75, No. 8, 27.04.2003, p. 1197-1203.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease
AU - Gridelli, Bruno
AU - Spada, Marco
AU - Petz, Wanda
AU - Bertani, Alessandro
AU - Lucianetti, Alessandro
AU - Colledan, Michele
AU - Altobelli, Monica
AU - Alberti, Daniele
AU - Guizzetti, Michela
AU - Riva, Silvia
AU - Melzi, Maria L.
AU - Stroppa, Paola
AU - Torre, Giuliano
PY - 2003/4/27
Y1 - 2003/4/27
N2 - Background. End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT). Methods. Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8). Results. Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively. Conclusions. SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.
AB - Background. End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT). Methods. Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8). Results. Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively. Conclusions. SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.
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U2 - 10.1097/01.TP.0000061940.96949.A1
DO - 10.1097/01.TP.0000061940.96949.A1
M3 - Article
C2 - 12717203
AN - SCOPUS:0037469041
VL - 75
SP - 1197
EP - 1203
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 8
ER -