Clin Transpl 1989;:143-52

Liver transplantation in children: University of Louvain Medical School (Brussels) experience with the first 139 patients

Otte JB, de Ville de Goyet J, Alberti D, de Hemptinne B, Sokal E, Moulin D,
Veyckemans F, Carlier MA, Van Obbergh L, Rahier J, et al
Department of Pediatric Surgery, Hopital St-Luc-Brussels-Belgium
Abstract
The children's liver transplantation program at the University of Louvain
Medical School in Brussels has been organized with a multidisciplinary pediatric
approach. The age distribution of the first 139 patients transplanted between
March 1984 and June 1989 is characterized by the distinct preponderance of
infants and small children (62.5% younger than 3 years, 16 younger than 1 year).
Biliary atresia unalleviated by the Kasai portoenterostomy or its modifications
was the single most frequent indication (101 cases) followed by the heterogenous
group of metabolic diseases (17 cases). Two children underwent combined liver
and kidney transplantation. A prominent feature of this series is the routine
use of the reduced-size liver (40% of the 171 grafts) to alleviate the shortage
of size-matched pediatric donors. The actuarial survival rate of the 139
children was 75.8% at 1 year and 72.4% at 2 years and thereafter. For patients
who received 1 graft electively, the 1-year survival rates were 85.2% and 92.5%
for those who received a full-size or a reduced-size liver with the same
proportion (83%) of long-term surviving patients having normal liver tests.
Long-term survival rates were not influenced by age, except for infants younger
than 1 year with 62.4% surviving at 1-year posttransplantation. This latter
group included a vast majority (14 of 16) of severely debilitated biliary
atresia cases in preterminal condition. Graft loss from rejection was kept at a
low rate of 5.2% (acute in 5-2.9% and chronic in 4-2.3%)