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Improved Outcomes in Liver Transplantation in Children With Acute Liver Failure

Oh, Seak Hee*; Kim, Kyung Mo*; Kim, Dae Yeon; Kim, Young*; Song, Seung Min*; Lee, Yeoun Joo*; Park, Seong-Jong*; Yoon, Chong Hyun; Ko, Gi-Young§; Sung, Kyu-Bo§; Hwang, Gyu-Sam||; Choi, Kyu-Taek||; Yu, Eunsil; Song, Gi-Won#; Ha, Tae-Yong#; Moon, Deok-Bog#; Ahn, Chul-Soo#; Kim, Ki-Hun#; Hwang, Shin#; Park, Kwang-Min**; Lee, Young-Joo**; Lee, Sung-Gyu#

Journal of Pediatric Gastroenterology and Nutrition: January 2014 - Volume 58 - Issue 1 - p 68–73
doi: 10.1097/MPG.0b013e3182a80362
Original Articles: Hepatology and Nutrition

Objective: The aim of our study was to review the experiences of a living donor–dominant transplantation program for children with acute liver failure (ALF).

Methods: Data were derived from the retrospective chart review of 50 children with ALF in a major liver center in the Republic of Korea.

Results: A total of 50 children with ALF underwent 47 (94%) primary living donor liver transplantations and 3 (6%) cadaveric liver transplantations. The cumulative survival rates of the grafts at 1 and 5 years were 81.9% and 79.2%, respectively. The overall retransplantation rate was 12%. The cumulative survival rates of these patients at 1 and 5 years were all 87.9%. Most incidents of mortality followed the failure of the preceding graft. We observed no mortalities among donors. Based on multivariate analysis, children who had pretransplant thrombocytopenia or had to use the molecular adsorbent recycling system preoperatively were related to the graft loss. Age younger than 2 years and a hyperacute onset (within 7 days) of hepatic encephalopathy were associated with pretransplant thrombocytopenia.

Conclusions: Living donor–dominant transplantation program in the present study demonstrates tolerable achievements in terms of clinical outcomes of recipients and donors; however, putative factors, such as pretransplant thrombocytopenia, seem to play unclear roles in a poor prognosis following transplantation.

*Department of Pediatrics

Department of Pediatric Surgery

Department of Pediatric Radiology

§Department of Radiology

||Department of Anesthesiology

Department of Pathology

#Division of Hepato-Biliary Surgery and Liver Transplantation

**Department of Surgery, Division of Hepato-Biliary and Pancreas Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Kyung Mo Kim, MD, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 388-1 Pungnap-Dong, Songpa-Gu, Seoul 138-736, Korea (e-mail: kmkim@amc.seoul.kr).

Received 3 August, 2013

Accepted 3 August, 2013

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,