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. 2018 Feb 23;13(2):e0193327.
doi: 10.1371/journal.pone.0193327. eCollection 2018.

Acute liver failure in children-Is living donor liver transplantation justified?

Marek Szymczak  1 , Piotr Kaliciński  1 , Grzegorz Kowalewski  1 , Dorota Broniszczak  1 , Małgorzata Markiewicz-Kijewska  1 , Hor Ismail  1 , Marek Stefanowicz  1 , Adam Kowalski  1 , Joanna Teisseyre  1 , Irena Jankowska  2 , Waldemar Patkowski  3
Affiliations

Acute liver failure in children-Is living donor liver transplantation justified?

Marek Szymczak et al. PLoS One. .

Abstract

Objectives: Living donor liver transplantation (LDLT) in patients with acute liver failure (ALF) has become an acceptable alternative to transplantation from deceased donors (DDLT). The aim of this study was to analyze outcomes of LDLT in pediatric patients with ALF based on our center's experience.

Material and methods: We enrolled 63 children (at our institution) with ALF who underwent liver transplantation between 1997 and 2016. Among them 24 (38%) underwent a LDLT and 39 (62%) received a DDLT. Retrospectively analyzed patient clinical data included: time lapse between qualification for transplantation and transplant surgery, graft characteristics, postoperative complications, long-term results post-transplantation, and living donor morbidity. Overall, we have made a comparison of clinical results between LDLT and DDLT groups.

Results: Follow-up periods ranged from 12 to 182 months (median 109 months) for LDLT patients and 12 to 183 months (median 72 months) for DDLT patients. The median waiting time for a transplant was shorter in LDLT group than in DDLT group. There was not a single case of primary non-function (PNF) in the LDLT group and 20 out of 24 patients (83.3%) had good early graft function; 3 patients (12.5%) in the LDLT group died within 2 months of transplantation but there was no late mortality. In comparison, 4 out of 39 patients (10.2%) had PNF in DDLT group while 20 patients (51.2%) had good early graft function; 8 patients (20.5%) died early within 2 months and 2 patients (5.1%) died late after transplantation. The LDLT group had a shorter cold ischemia time (CIT) of 4 hours in comparison to 9.2 hours in the DDLT group (p<0.0001).

Conclusions: LDLT is a lifesaving procedure for pediatric patients with ALF. Our experience showed that it may be performed with very good results, and with very low morbidity and no mortality among living donors when performed by experienced teams following strict procedures.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patients’ survival after LDLT and DDLT in the ALF group with the Kaplan-Meier comparison.
Fig 2
Fig 2. Graft survival after LDLT and DDLT in ALF groups as evaluated by the Kaplan-Meier comparison.
See this image and copyright information in PMC

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