소아 생체 간 이식 경험 250례에 대한 단일 센터 보고
Lessons Learned From 250 Pediatric Living Donor Liver Transplantations in a Single Center
Abstract
Objectives: The experience of pediatric living donor transplantation (LDLT) has been accumulating since its first performance in 1989. We aimed to learn the characteristics and outcome of pediatric LDLT for 20 years in Asan medical center located in Korea. Methods: This retrospective review between 1994 and 2016 included 250 pediatric cases with LDLT performed at a single center. Recipients whose first liver transplant (LT) was deceased donor were excluded. Outcome was analyzed by comparing the patient and graft survival in two groups, 1994-2005 and 2006-2016. Results: Two hundred fifty LDLT were performed in 241 children. Thirty patients (5.4%) required a first re-transplantation, 3 patients (1.2%) required a second re-transplantation. ABO incompatible LDLT were performed in 13 cases (5.4%). Median age at liver transplantation was 1.7 years (range, 0.25-17). Median body weight at liver transplantation was 11kg (range, 4.9-80). Graft-recipient weight ratios were 4.1% (range, 2.5-5.8), 3.0% (range, 1.5-4.5), 1.8% (range, 1.0-3.3), 1.4% (range, 0.9-1.6), and 0.9% (range, 0.7-1.7) in weight 6 or less, 7-10, 11-20, 21-30, and 31kg and more, respectively. The top 3 causes of LT were biliary atresia (118/241, 49%), acute liver failure (54/241, 22.4%), and Wilson disease (17/241, 7.1%). Two hundred fifty two grafts including 2 dual donors were used in this study. The median age of donors was 33 years (range, 16-55). The fatty change of graft was the most frequent in 0-10% (180/210, 85.8%). From 1994 to 2005, cumulative patient/graft survival rates at 1-, 5-, and 10-year were 89.8/88.2, 83.3/81.8, and 82.4/80.0%, respectively. Patient survival rates at 1-, 5-, and 10-year survival rates after 2006 were significantly increased 94.8/92.9, 94.8/91.1, and 93.5/91.1%, respectively. Conclusion: The outcome of pediatric LDLT in this series has been improved over time, as the short-term success in survival reflected the long-term outcome.