Liver transplantation in infants younger than 1 year of age

Paul M. Colombani, Francisco G. Cigarroa, Kathleen Schwarz, Barbara Wise, Warren E. Maley, Andrew S. Klein

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Objective: The authors report on experience with liver transplantation for infants younger than 1 year of age. Summary Background Data: Over the last 15 years, orthotopic liver transplant has become the only lifesaving procedure available for infants with end stage liver disease. Many transplant centers initially required infants to reach a specific weight or age to minimize morbidity and modality. Size-appropriate infant donors also were uncommon. As a result, many children, in the first few years of life, died of their disease. The availability of reduced-size cadaveric and living related liver transplants has offered the ability to transplant the young infant with liver failure. Methods: The authors instituted a program to aggressively transplant infants with liver failure in the first year of life using both cadaveric and living-related liver donors. Results: Between June 1991 and January 1995, 13 infants were transplanted for rapidly progressive liver failure. Infant age ranged from 4 to 11 months (mean, 7.5 months). The cause of liver failure included biliary atresia (11), α1-antitrypsin deficiency (1), and liver failure secondary to echovirus 7 (1). The United Network for Organ Sharing status at the time of transplant ranged from status 4, intensive care unit bound (4 patients); status 3, hospitalized (4 patients); or status 2, failing at home (5 patients). Six patients (46%) received cadaveric whole organ (2) or segmental transplants (4). Seven patients (54%) received left lateral segment living-related transplants from parental donors. After operation, patients received cyclosporine or FK506-based immunosuppression. Three patients (23%) required four retransplants (two cadaveric for primary nonfunction; one living-related for graft thrombosis in the face of fungal infection and bile leak). Postoperative complications included primary nonfunction (15%), rejection (85%), graft vascular thrombosis (15%, two of three revascularized successfully), bacterial and fungal infections (77%), and viral infections (46%). Epstein-Barr virus-associated lymphoproliferative developed in two patients (15%). Intestinal perforation requiring reoperation developed in two patients (15%). Bile leaks requiring reoperation or transhepatic stinting or both developed in three patients (23%). Two patients died in the perioperative period (< 1 month) from a combination of primary nonfunction or graft thrombosis and sepsis. Overall survival was 85%, ranging from 11.0 months to 45 years. Conclusions: Orthotopic liver transplantation in infants younger than 1 year of age poses significant challenges from technical and infectious complications. Despite these barriers, overall patient survival is comparable to that of older children and adults.

Original languageEnglish (US)
Pages (from-to)658-664
Number of pages7
JournalAnnals of Surgery
Volume223
Issue number6
DOIs
StatePublished - Jul 1 1996
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Colombani, P. M., Cigarroa, F. G., Schwarz, K., Wise, B., Maley, W. E., & Klein, A. S. (1996). Liver transplantation in infants younger than 1 year of age. Annals of Surgery, 223(6), 658-664. https://doi.org/10.1097/00000658-199606000-00004