Pediatric

Pediatric Liver Transplantation in the Shiraz Transplant Center S.-A. Malek-Hosseini, H. Salahi, A. Bahador, M.-H. Imanieh, A. Mehdizadeh, A. Razmkon, M.-H. Anbardar, and S. Gholami

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IVER TRANSPLANTATION was performed for the first time in 1963, but for more than two decades it remained an experimental method with low success and high mortality rates.1,2 Nowadays, with new surgical methods and new immunosuppressive drugs, liver transplantation is accepted as the best and sometimes even the only way to cure some life-threatening liver diseases.3,4 It is a successful and useful therapy for children with chronic or end-stage liver disease and those with a variety of extrahepatic metabolic diseases can be corrected by liver replacement.5 Liver transplantation has been done throughout Iran and some neighboring countries exclusively in our center for 12 years. Potential recipients from all over the country or neighboring countries are selected for the waiting list based on the established indications for liver transplantation. The objective of this study was to analyze a single center’s 12-year experience with 24 pediatric patients with end-stage liver diseases. MATERIALS AND METHODS The first 150 consecutive liver transplantations were performed between 14 April 1993 and 15 February 2005 in Shiraz (Southern Iran) Organ Transplant Center. We evaluated the 24 pediatric liver transplantations retrospectively, using the liver transplantation database with a minimum follow-up period of 6 months. To collect data, we used new software from the Persian Network for Organ Transplant (PNOT), which was prepared in the Shiraz center and included all identifying laboratory data, imaging reports, and consultations for every patient. We evaluated the 1-, 2-, and 3-year patient survival rates, the source of the transplanted organ, whether it was from a living or cadaveric donor, and postoperative complications till now. All data were recorded in Microsoft Excel 2003 and SPSS 10 software and analyzed by this software.

cryptogenic cirrhosis (41.6%), autoimmune hepatitis (20.8%), biliary atresia (20.8%), neonatal cirrhosis (12.5%), and biliary hypoplasia (4.3%). Rejection occurred in 27% of cases once and 8% twice. The most common short-term complications included respiratory complications (12%), neurologic complications (10%), and biliary complications (10%). Long-term complications included rejection (9%), renal failure (6%), and death (15%). The 1-, 2-, and 3-year patient survival rates were 92%, 89%, and 85%, respectively. DISCUSSION

The success of pediatric orthotopic liver transplantation has improved greatly since its widespread application in the 1980s. No group has benefited more from this than infants younger than 1 year.6 The perfect performance of the procedure, reasonable immunosuppressive regimen, and prevention and prompt therapy of complications are the keys to achieve satisfactory results. However, with timely recognition and active intervention, a good outcome can be achieved.7 As the Shiraz Transplant Center is the only established pediatric liver transplant center in Iran, children are referred from all over the country and this dislocation from social support services, including family, friends, and the workplace, has major emotional and financial implications. Based on the analyzed data in this research study, and considering similar research projects performed at other major centers around the world, it can be concluded that although only 12 years old, this only center in the country has done well and is a great source of hope for the promotion of science and health. REFERENCES

RESULTS

Among 24 consecutive recipients, 75% were male and 25% were female. The average age of the recipients was 9.7 ⫾ 4.5 years (range, 0.92–15 years). Fifteen patients had a full-size cadaveric transplant; 9 patients received a graft from a living donor. Only two cases had split-liver transplantation. The operative procedure was performed in a standard manner using a duct-to-duct anastomosis in 68% of the cases; the piggyback technique was utilized in 90%, and venovenous bypass in the rest. All cases were first transplantations. The immunosuppressive regimen included Cellcept, cyclosporine, and methylprednisolone. Major causes of liver failure included 0041-1345/06/$–see front matter doi:10.1016/j.transproceed.2005.12.104 594

1. Valentin-Gamazo C, Malago M, Karliova M, et al: Experience after the evaluation of 700 potential donors for living donor liver transplantation in a single center. Liver Transplant 10:1087, 2004 2. McDiarmid SV, Anand R, Lindblad AS: Studies of pediatric liver transplantation: 2002 update. An overview of demographics, indications, timing, and immunosuppressive practices in pediatric liver transplantation in the United States and Canada. Pediatr Transplant 8:284, 2004 From the Nemazee Hospital, Shiraz (Southern Iran) Organ Transplant Center, Shiraz, Iran. Address reprint requests to Ali Razmkon, PO Box 71455-166, Shiraz, Iran. E-mail: [email protected] © 2006 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 38, 594 –595 (2006)

PEDIATRIC LIVER TRANSPLANTATION IN IRAN 3. Busuttil RW, Shaked A, Millis J, et al: One thousand liver transplants: the lessons learned. Ann Surg 219:490, 1994 4. Gilbert JR, Pascua M, Schoenfeld DA, et al: Evolving trends in liver transplantation. Transplantation 67:246, 1999 5. Rand EB, Olthoff KM: Overview of pediatric liver transplantation. Gastroenterol Clin North Am 32:913, 2003

595 6. Tiao GM, Alonso M, Bezerra J, et al: Liver transplantation in children younger than 1 year—the Cincinnati experience. J Pediatr Surg 40:268, 2005 7. Spearman CWN, McCulloch M, Millar AJW, et al: Liver transplantation for children: Red Cross Children’s Hospital experience. Transplant Proc 37:1134, 2005