LIVER XPLANTATION

liver411

November 2003 . Volume 9 . Number 11

Original Articles

Live donor liver transplantation for fulminant hepatic failure in children

Chi-Leung Liu*? ,Sheung-Tat Fan*? ,Chung-Mau Lo*?
Paul Kwong-Hang, Tam*? Htut Saing*? ,William Ignace Wei*?
Boon-Hun Yong?, Nai-Shun Tsoi§ ,John Wong*?

   Abstract
The mortality rate among children with fulminant hepatic failure (FHF) on
the waiting list for cadaveric donor liver transplantation (CDLT) is high.
Results of emergency CDLT in this situation often are unsatisfactory, and a
long-term survival rate less than 30% has been reported. Live donor liver
transplantation (LDLT) for FHF in children has been advocated, but is
reported rarely. We present our experience with LDLT in children with FHF.
Between September 1993 and December 2002, primary LDLT was performed for 26
children; 8 of these children had FHF. Patient demographics, clinical and
laboratory data, surgical details, complications, and graft and patient
survival are reviewed. Four boys and four girls received left-lateral
segment (n = 7) and full left-lobe (n = 1) grafts. Mean age was 2.9 ± 1.2
years (range, 3 months to 11 years). Causes of FHF were drug induced in 2
patients and idiopathic in 6 patients. One child received a blood
group-incompatible graft. Two patients died; 1 patient of cytomegalovirus
infection at 8.6 months and 1 patient of recurrent hepatitis of unknown
cause at 2.8 months after LDLT. The child who received a mismatched graft
had refractory rejection and underwent a second LDLT with a blood
group-compatible graft 19 days afterward. He eventually died of
lymphoproliferative disease. Another patient developed graft failure related
to venous outflow obstruction and survived after retransplantation with a
cadaveric graft. With a median follow-up of 13.2 months (range, 2.8 to 60.3
months), actuarial graft and patient survival rates were 50% and 62.5%,
respectively. Survival results appear inferior compared with those of 18
children who underwent LDLT for elective conditions during the same study
period (graft survival, 89%; P = .051; patient survival, 89%; P = .281).
Although survival outcomes are inferior to those in elective situations,
LDLT is a timely and lifesaving procedure for children with FHF. (Liver
Transpl 2003;9:1185-1190.)

   Publishing and Reprint Information
From the *Centre for the Study of Liver Disease, and Departments of
?Surgery, ?Anesthesiology, and §Pediatrics, University of Hong Kong Medical
Centre, Queen Mary Hospital, Hong Kong, China.
Supported in part by a Committee on Research and Conferences Grant and a
Distinguished Research Achievement Award of the University of Hong Kong.
Address reprint requests to Chi-Leung Liu, MS, FRCS (Edin), FACS, Department
of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102
Pokfulam Rd, Hong Kong, China. Telephone: 852-2855-3996; FAX: 852-2817-5475;
E-mail: [email protected]
Copyright © 2003 by the American Association for the Study of Liver Diseases
1527-6465/03/0911-0009$30.00/0
doi:10.1053/jlts.2003.50235

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