The evolution of pediatric liver transplantation in the Netherlands over the past two decades

M.J.M. Werner, R.H.J. de Kleine, F.A.J.A. Bodewes, M.T. de Boer, K.P. de Jong, V.E.D.M. de Meijer, R. Scheenstra

Thursday 15 march 2018

12:40 - 12:50h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 5: Clinical

Introduction

Since 1982, pediatric liver transplantation has been increasingly performed in the Netherlands, with currently op to 25 pediatric liver transplantations each year. Donor availability is the main limiting factor in liver transplantation, especially in children, who need a perfect size appropriate graft. To expand the donorpool for children, living donor liver transplantation (LDLT) was introduced in the Netherlands in 2004, and its use has dramatically increased nowadays.

Aim

Evaluation of pediatric liver transplantations in the Netherlands over the past two decades.

Methods

A retrospective cohort study was performed of all pediatric patients who underwent primary liver transplantation in the Netherlands from 1995-2016. The outcomes of children after liver transplantation during 1995-2005 (cohort A; n=126) were compared to children transplanted during 2006-2016 (cohort B; n=169). A sub-analysis was performed in cohort B between liver transplantations with deceased donor livers (n=132) and LDLT (n=37).

Results

Almost all transplants in cohort A were derived from deceased donors (99%), whereas in cohort B 37 LDLTs (22%) were performed. In 2016, 50% of the pediatric primary liver transplantations were LDLT. The median age was significantly higher in cohort A, when compared to cohort B (4.4 vs. 2.5 years; p=0.015). Postoperative complications were comparable for both cohorts. Retransplantations within a year after liver transplantation were more often performed in cohort A, when compared to cohort B (25% vs. 12%; p=0.004). Only 2 patients (5.4%) after LDLT underwent retransplantation. Five-year survival in cohort B was significantly better, compared to cohort A (83% vs. 71%; p=0.014). LDLT was associated with a significantly better 5-year survival, when compared to deceased donor liver transplantation (95% vs. 81%; p=0.025).

Conclusion

Outcomes after pediatric liver transplantation in the Netherlands have improved over the last two decennia. With an actuarial 5-year survival of 83%, and even 95% for LDLT, we present a successful national pediatric liver transplant program.