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Özen J, Beime J, Brinkert F, Fischer L, Herden U, Grabhorn E. Short- and long-term results of liver transplantation according to age at transplant: a single-center experience of 351 children. Transpl Int 2021; 34:1251-1260. [PMID: 33772883 DOI: 10.1111/tri.13872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023]
Abstract
Pediatric liver transplantation (PLT) has very good results at experienced transplant centers. However, there is still an ongoing discussion about inferior outcomes, especially in young infants. The aim of this retrospective study was to evaluate outcomes of infants compared to older recipients in a single center over 20 years. We conducted a retrospective study of children who received liver transplants at our center between 1991 and 2011. Only patients without other limiting organ involvement were included and compared according to age. The inclusion criteria were fulfilled by 351 patients (173 vs. 178). The most common indication in both groups was biliary atresia (82.1% vs. 49.4%). The 1-, 5-, and 10-year patient survivals were 93.8%/91.8%/91.1% and 93%/90.8%/90.1%, and the graft survivals were 90.4%/83.5%/79.6% and 89.4%/81.8%/77.5%, respectively. Complications such as postoperative bleeding, biliary complications, or perfusion impairment occurred more often in infants. Leading indications for retransplantation (vascular complications/primary nonfunction) and leading causes of death (sepsis/multiorgan failure) were the same in both groups. Significant predictors for patient loss were decade of transplantation, retransplantation, postoperative bleeding, and infections for infants. Predictors for graft loss were bowel perforation, arterial thrombosis, and age >12 months. Children can have excellent results, independent of age at PLT.
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Affiliation(s)
- Julia Özen
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Beime
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enke Grabhorn
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Schröder H, Junge N, Herden U, Deutschmann A, Weidemann SA, Krebs-Schmitt D, Grabhorn EF. Outcome of liver transplantation and prevalence of liver fibrosis in Crigler-Najjar syndrome. Clin Transplant 2021; 35:e14219. [PMID: 33544952 DOI: 10.1111/ctr.14219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Crigler-Najjar syndrome (CNS) is a rare inherited disorder that is characterized by high levels of non-hemolytic, unconjugated hyperbilirubinemia leading to brain damage and even death. Liver transplantation (LT) can correct the metabolic defect, but there are little data regarding LT in this patient cohort. The liver parenchyma has been considered to be structurally normal in CNS, but there is growing evidence of clinically silent but histologically significant fibrosis in CNS patients. PATIENTS AND METHODS We included 13 patients in our retrospective study who underwent LT at our center. Patient survival, graft function, and long-term complications were evaluated over a median follow-up period of 10 years (range: 1-16 years). In addition, the prevalence of histologically relevant fibrosis was characterized. RESULTS The overall survival among our LT patients was 100%. The graft survival was only 61.5%. During the follow-up period, 5 LT patients had to undergo retransplantation. More than 45% of our patients showed histological signs of fibrosis. CONCLUSION LT remains the only definite therapeutic option for severe CNS but needs to be considered thoroughly regarding the clinical risk-benefit-ratio and impact on quality of life. Furthermore, hepatic parenchymal injury needs to be considered while evaluating future therapeutic options for CNS.
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Affiliation(s)
- Hanna Schröder
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norman Junge
- Department of Pediatrics, University Medical Center Hanover, Hanover, Germany
| | - Uta Herden
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Deutschmann
- Department of Pediatrics, Medical University Hospital of Graz, Graz, Austria
| | | | | | - Enke Freya Grabhorn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Berry GT, Blume ED, Wessel A, Singh T, Hecht L, Marsden D, Sahai I, Elisofon S, Ferguson M, Kim HB, Harris DJ, Demirbas D, Almuqbil M, Nyhan WL. The re-occurrence of cardiomyopathy in propionic acidemia after liver transplantation. JIMD Rep 2020; 54:3-8. [PMID: 32685343 PMCID: PMC7358669 DOI: 10.1002/jmd2.12119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiomyopathy is a frequent complication of propionic acidemia (PA). It is often fatal, and its occurrence is largely independent of classic metabolic treatment modalities. Liver transplantation (LT) is a treatment option for severe PA as the liver plays a vital role in metabolism of the precursors that accumulate in patients with PA. LT in PA is now considered to be a long-lasting and valid treatment to prevent cardiac disease. The subject of this report had severe cardiomyopathy that largely disappeared prior to undergoing a LT. Three years following the transplant, there was recurrence of cardiomyopathy following a surgery that was complicated with a postoperative aspiration pneumonia. On his last hospital admission, he was presented with pulmonary edema and heart failure. He continued with episodes of intractable hypotension, despite maximum inotropic and diuretic support. He died following redirection of care. We conclude that lethal cardiomyopathy may develop several years after successful LT in patients with PA.
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Affiliation(s)
- Gerard T. Berry
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth D. Blume
- Department of Cardiology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ann Wessel
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Tajinder Singh
- Department of Cardiology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Leah Hecht
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Deborah Marsden
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Inderneel Sahai
- Pediatrics‐Genetics Department, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Scott Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael Ferguson
- Division of Nephrology, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Heung Bae Kim
- Department of Surgery, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - David J. Harris
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Didem Demirbas
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Mohammed Almuqbil
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - William L. Nyhan
- Department of PediatricsUniversity of California San DiegoLa JollaCaliforniaUSA
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Developmental assessment of infants with biliary atresia: differences between boys and girls. J Pediatr Gastroenterol Nutr 2012; 55:384-9. [PMID: 22516863 DOI: 10.1097/mpg.0b013e318259ed20] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the present study was to investigate whether male and female infants with biliary atresia (BA) differ cognitively and to confirm previously documented developmental lags in infants with BA before liver transplantation. METHODS With the Mullen Scales of Early Learning, we examined 21 female and 12 male infants (ages 3-20 months) with BA, comparing scores across indices by sex and correlating Mullen Scales of Early Learning scores with standard clinical and biochemical parameters. RESULTS Overall, both boys and girls were found to be vulnerable to developmental lags in the areas of expressive language (EL) and gross motor skills. In comparison with their male peers, girls were found to be weaker in the area of visual reception skills (P=0.05) with a trend found for EL (P=0.08). Girls were also found to have higher C-bilirubin levels and to be of shorter length. Growth parameters were found to be correlated with EL scores. International normalized ratio was found to be correlated with gross motor performance and with a trend also noted for fine motor skills. Age at Kasai predicted receptive language skills. CONCLUSIONS As has been shown, infants with BA appear to be vulnerable to developmental lags before transplantation. In particular, female infants appear to be vulnerable to cognitive and skill delays in comparison with their male peers. C-bilirubin levels may play a role in this increased vulnerability for females.
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Liver Transplantation in Infants with Body Mass Less than 6 KG. POLISH JOURNAL OF SURGERY 2009. [DOI: 10.2478/v10035-009-0010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barshes NR, Vanatta JM, Patel AJ, Carter BA, O'Mahony CA, Karpen SJ, Goss JA. Evaluation and management of patients with propionic acidemia undergoing liver transplantation: a comprehensive review. Pediatr Transplant 2006; 10:773-81. [PMID: 17032422 DOI: 10.1111/j.1399-3046.2006.00569.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Propionic acidemia is a rare metabolic disorder that often results in episodic hyperammonemia, basal ganglia infarction, mental retardation, and cardiomyopathy. OLT has been used as a treatment for propionic acidemia, but its benefit in patients with this disease is unclear. The current study was undertaken to clarify the role of OLT in the management of this disease. The medical literature, a national registry of US OLT recipients, and a single institution liver transplant experience were reviewed for cases of OLT for propionic acidemia. Accumulated cases demonstrate that OLT has resulted in clear evidence of clinical improvement in several patients, often obviating the need for dietary restriction or other forms of medical management. OLT appears to halt the decline in neurocognitive function often associated with propionic acidemia. In total, 12 patients with propionic acidemia have undergone a total of 14 OLTs. A quantitative analysis of outcomes shows an overall patient survival rate of 72.2% at one year after OLT. In conclusion, OLT should be considered a treatment option for patients with propionic acidemia who continue to experience episodes of hyperammonemia in spite of maximal medical therapy. Early OLT may limit the development of mental retardation and/or cardiomyopathy.
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Affiliation(s)
- Neal R Barshes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Barshes NR, Lee TC, Balkrishnan R, Karpen SJ, Carter BA, Goss JA. Orthotopic liver transplantation for biliary atresia: the U.S. experience. Liver Transpl 2005; 11:1193-200. [PMID: 16184564 DOI: 10.1002/lt.20509] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in the pediatric population. The outcomes of liver transplantation for biliary atresia, however, have not been formally examined on a national scale. The objective of this study was to identify pretransplant variables that predict patient survival after primary liver transplantation for biliary atresia. A cohort of 1,976 pediatric patients undergoing primary liver transplantation for biliary atresia between 1/1988 to 12/2003 was enrolled from the United Network for Organ Sharing database after excluding patients with a history of multiorgan transplant or previous liver transplant. Follow-up data up to 16 years post-OLT was available. The 5- and 10-year actuarial survival rates of patients that underwent liver transplantation for biliary atresia in the United States are 87.2% and 85.8%, respectively, and the 5- and 10-year graft actuarial survival rates are 76.2% and 72.7%, respectively. Early deaths (< or =90 days post-OLT) were more often caused by graft failure (P = 0.01), whereas late deaths (>90 days post-OLT) were more often due to malignancy (P < 0.01). An analysis of outcomes over time demonstrated a decrease in post-OLT survival and an increase in the number of OLTs done for biliary atresia at an increasing number of centers. A multivariate analysis revealed that cadaveric partial/reduced liver grafts, a history of life support at the time of OLT, and decreased age were independent predictors of increased post-OLT mortality. In conclusion, OLT is an effective treatment for biliary atresia. Certain pretransplant variables may help predict patient survival following liver transplantation for biliary atresia.
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Affiliation(s)
- Neal R Barshes
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Grabhorn E, Schulz A, Helmke K, Hinrichs B, Rogiers X, Broering DC, Burdelski M, Ganschow R. Short- and Long-Term Results of Liver Transplantation in Infants Aged Less than 6 Months. Transplantation 2004; 78:235-41. [PMID: 15280684 DOI: 10.1097/01.tp.0000128189.54868.18] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite major surgical and medical advances, it is still a challenge to perform transplantation in small infants. This study, focusing on short- and long-term outcomes, summarizes our 10-year experience with liver transplantation (LTx) in infants aged less than 6 months. PATIENTS AND METHODS We analyzed 43 patients aged 6 months or less (range: 12-184 days, median: 136 days) whose median weight at the time of LTx was 5.8 kg (range: 2.8-8.0 kg). The reasons for LTx were biliary atresia (n=27; 62.8%), neonatal hepatitis (n=6; 14%), neonatal cholestasis (n=4; 9.3%), and miscellaneous (n=6; 14%). The patients were followed up for a median time of 3 years and evaluated with respect to graft function, physical, and neurodevelopmental outcome. RESULTS The patient survival was 90.7% after 1 year and 87.2% after 2 years. The graft survival was 86% after 1 year and 82.1% after 2 years. Twelve patients (27.9%) experienced 15 surgical complications requiring intervention, two of whom demonstrated vascular thrombosis (4.7%). Acute early rejection occurred in 15 patients (34.9%), and chronic rejection occurred in 3 patients (7%); 83.3% of the patients had normal liver function test results at the time of evaluation. Complications such as posttransplant lymphoproliferative disease (4.7%) and persistent arterial hypertension (4.7%) were rarely seen. The physical and neurodevelopmental outcomes were good. CONCLUSIONS LTx in infants aged less than 6 months provides excellent short- and long-term results. Low weight or young age of infants awaiting LTx should not be exclusion criteria for LTx.
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Affiliation(s)
- Enke Grabhorn
- Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
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