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Indian Pediatr 2009;46: 1088-1090 |
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Early Postoperative Complications of Pediatric
Liver Transplantation |
Mohammad Hadi Imanieh*†, Asma Erjaee†, Seyed Mohsen Dehghani*†, Ali
Bahador* and
Seyed Ali Malek-Hosseini*
From *Shiraz Transplant Research Center, and †Gastroenterohepatology
Research Center, Department of Pediatric Gastroenterology, Nemazee
Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Correspondence to: Dr Seyed Mohsen Dehghani, Shiraz
Transplant Research Center, Gastroenterohepatology Research Center,
Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz
7193711351, Iran.
Email: [email protected]
Received: June 25, 2007;
Initial review: September 21, 2007;
Accepted: September 11, 2008.
Published online 2009 April 1
PII: S0974757900413-2
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Abstract
We reviewed records of 35 pediatric liver transplant
recipients who were operated at the Shiraz Organ Transplant Center
between April 1998 and April 2005 to gather demographic data, primary
diagnosis, duration of hospital stay, source of graft, mortality, and
surgical (vascular, biliary, fluid collection) and medical (infection,
respiratory, neurological, cardiovascular, and gastrointestinal)
complications. Among 23 male and 12 female pediatric liver transplant
recipients (mean age: 11.8±4.9 years) with a mean hospital stay duration
of 23.3±20.3 days, the postoperative complications included biliary
leakage (7.20%), biliary stricture (3.10%), biliary obstruction (3.10%),
pleural effusion (9.26%), lung collapse (n=1) pulmonary
hemorrhage (n=1), and vascular complications of portal and
hepatic vasculature (n=10, 28.6%); and infections of the
peritoneum, lung, wound site, and urinary tract (n=10; 28.6%).
Acute cellular rejection was documented in 6 (17.1%) recipients.
Overall, 13 (37.1%) children died.
Key words: Children, Complication, Iran, Liver transplant.
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O rthotopic
liver transplantation (OLT) is the treatment of choice for all types of
end-stage liver diseases in both children and adults(1-3); it was first
used as a treatment for pediatric chronic liver disease in 1998 at our
center. Despite the improvement in survival due to advances in organ
preservation, improved immunosuppressive agents, and refinement of surgical
techniques, there are still significant complications and mortality
associated with pediatric OLT(3,4). The aim of this study was to determine
the type and frequency of early postoperative complications that occurred
among our pediatric liver transplant recipients.
Methods
We reviewed the records of 35 pediatric patients (less
than 18 years old) who underwent first OLT at Shiraz Organ Transplant
Center between April 1998 and April 2005. The operative procedure was
preformed in a standard manner, using duct-to-duct anastomosis in 68% of
cases and piggy-back technique was utilized in 90% and venovenous bypass
in the rest. Immunosuppressive regimen included mycophenolate mofetil,
cyclosporine, tacrolimus and prednisolone. Data including demographic
characteristics, primary diagnosis, duration of hospital stay, source of
graft, mortality, and early postoperative complications were gathered.
Early postoperative complications were considered as any surgical or
medical complication that occurred any time during the patient’s hospital
stay following transplantation.
Results
Twenty- three of the 35 pediatric liver transplant
recipients were male and 12 were female. The mean age of the recipients
was 11.8±4.9 years (range, 11 mo-18 yr). 77% of the patients used organs
from deceased donors and 22.9% from living sources. The primary diagnoses
for these patients included cryptogenic cirrhosis (n=17, 48.6%),
autoimmune cirrhosis (n=7, 20%), biliary atresia (n=5,
14.3%), Wilson disease (n=4, 11.4%) and neonatal hepatitis (n=2,
5.7%). The mean duration of hospital stay was 23.3±20.3 days. The
complications are listed in Table I. Pleural effusion (n=9)
was the most common respiratory complication. There was one case each of
lung collapse and pulmonary hemorrhage. In all cases, the right hemithorax
was affected. Re-laparatomy was needed in 11 (31.4%) cases due to
complications. Outcome did not vary with the kind of complication and the
need for re-laparatomy.
Table I
Complications of Liver Transplant
|
Total |
Living |
Cadaver |
Surgical complications |
Hepatic artery thrombosis |
3 (8.6%) |
0 |
3 (11.1%) |
Portal vein thrombosis |
4 (11.4%) |
1 (12.5%) |
3 (11.1%) |
Portal vein stenosis |
1 (2.9%) |
1 (12.5%) |
0 |
Hepatic artery stenosis |
1 (2.9%) |
1 (12.5%) |
0 |
Hepatic artery pseudoaneurysm |
1 (2.9%) |
1 (12.5%) |
0 |
Biliary leakage |
7 (20.0%) |
3 (37.5%) |
4(14.8%) |
Biliary stricture |
3 (8.6%) |
1(12.5%) |
2 (7.4%) |
Biliary obstruction |
3 (8.6%) |
1 (12.5%) |
2 (7.4%) |
Liver ischemia |
0% |
0 |
0 |
Liver infarction |
0% |
0 |
0 |
Liver abscess |
2 (5.7%) |
2 (25.0%) |
0 |
Fluid collection |
5 (14.3%) |
1 (12.5%) |
4 (14.8%) |
Hematomas |
6 (17.1%) |
0 |
6 (22.2%) |
Medical complications |
Infection |
10 (28.6%) |
1 (12.5%) |
9 (33.3%) |
Respiratory |
11 (31.4%) |
5 (62.5%) |
6 (22.2%) |
Neurological |
6 (17.1%) |
1 (12.5%) |
5 (18.5%) |
Cardiovascular |
3 (8.6%) |
1 (12.5%) |
2 (7.4%) |
Gastrointestinal bleeding |
2 (5.7%) |
1 (12.5%) |
1 (3.7%) |
Rejection |
6 (17.1%) |
2 (25.0%) |
4 (14.8%) |
Others (alopeciaareata,
hallucination) |
4 (11.4%) |
1 (12.5%) |
3 (11.1%) |
The infection sites included peritoneum (n=3),
lungs (n=2), wounds (n=2) and the urinary system (n=1).
Micro-organisms involved were fungal in 2 cases, viral (herpes and CMV) in
2 cases and bacterial in 6 others. Acute cellular rejection occurred in 6
(17.1%) cases; of these 4 died. All 10 cases with arterial and venous
thrombosis also died. Overall mortality rate over one year was 37.1 % (n=13).
The causes of death were rejection, vascular complications, hypoglycemia,
gastrointestinal bleeding, and lymphoproliferative disorder.
Discussion
Liver transplant recipients are at risk for the same
postoperative complications as any patient under-going a major
intraabdominal operation, in addition to several complications specific to
this pro-cedure(5). At least one early postoperative complication was seen
in 27 pediatric OLT patients in our study. We observed that biliary and
vascular complications were the most frequent early post-operative
surgical complications while respiratory, infectious, and acute rejection
complications were the most common medical problems in the early post
surgical period. Similar complications have been reported by other authors
(3,4,6-10).
We conclude that the liver transplant complications
found in the pediatric age group at our center were very similar to that
found in other transplant centers worldwide(4-7). However, considering the
fact that our study had evaluated the outcome of liver transplantation in
the first few years of pediatric liver transplant surgery, our overall
mortality rate is higher compared to similar studies from the West.
Contributors: MHI: idea of research, data
collection, drafting; AE; data collection and analysis, drafting; AB: data
collection and drafting; SAM: data collection and critical revision. All
authors approved the final paper.
Funding: Shiraz University of Medical Sciences.
Competing interests: None stated.
What This Study Adds?
• Overall mortality rate of liver transplant in
children in Iran was 37.1% but the postoperative complications were
similar to previous studies.
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