European Liver Transplant Registry: donor and transplant surgery aspects of 16,641 liver transplantations in children
de Ville de Goyet, Jean Baumann, Ulrich Karam, Vincent Adam, René Nadalin, Silvio Heaton, Nigel Reding, Raymond Branchereau, Sophie Mirza, Darius Klempnauer, Jürgen L
de Ville de Goyet, Jean
Baumann, Ulrich
Karam, Vincent
Adam, René
Nadalin, Silvio
Heaton, Nigel
Reding, Raymond
Branchereau, Sophie
Mirza, Darius
Klempnauer, Jürgen L
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2021-12-16
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Abstract
Background and aims: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.
Approach and results: Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found.
Conclusions: Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
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de Ville de Goyet J, Baumann U, Karam V, Adam R, Nadalin S, Heaton N, Reding R, Branchereau S, Mirza D, Klempnauer JL, Fischer L, Kalicinski P, Colledan M, Lopez Santamaria M, de Kleine RH, Chardot C, Yilmaz S, Kilic M, Boillot O, di Francesco F, Polak WG, Verkade HJ; European Liver, Intestine Transplant Association. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children. Hepatology. 2022 Mar;75(3):634-645. doi: 10.1002/hep.32223. Epub 2021 Dec 16
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