Pediatric Liver Transplant Outcomes Better Than Ever

By Bijan Eghtesad, MD

When children are diagnosed with biliary atresia, alpha-1- antitrypsin deficiency or another condition leading to end-stage liver disease, liver transplantation may eventually be required.  This typically occurs prior to age 2 or during the teenage years.   In 40 to 50 percent of children, biliary atresia is the reason that liver transplantation is required, usually before age 5 (median: 1 to 2 years).  The "ideal" donor is similar in size; yet despite this large number of potential recipients, few donors are under age 5.

Wait-listing babies a concern

This mismatch produced excessive waiting-list mortality among smaller children, prompting the development of innovative techniques like reduced-size, and later on, split-liver transplantation.  Yet the waiting time and resulting mortality rate for small children remained high until increased expertise in split-liver transplantation led to a successful attempt at live-donor liver transplantation (LDLT) in 1989.  Due to the need for this alternative, especially in pediatric populations, several centers in this country and around the world rapidly adopted and advanced LDLT.  As a result, the high mortality rates for smaller children dropped from 25 percent to almost zero in less than 15 years.

Equal or better outcomes with LDLT

This not only resulted in an increase in the number of pediatric liver transplants; it also produced long-term post-transplant outcome data suggesting equal, if not better, survival in children receiving LDLT versus cadaveric grafts.  The one-year patient survival rate following LDLT is now between 88 and 94 percent.  In Cleveland Clinic's Pediatric Liver Transplantation Program, we pledge to do everything possible to make transplant a reality for such patients, from infancy through their late teens.  We offer every transplant option imaginable, including whole-organ, split-graft and live-donor transplants.  We use state-of-the-art techniques, and laboratory and radiologic advances provide us with more information on our patients than ever before, so that we can better evaluate them and plan the best treatment strategies.

20 successful transplants in 4 years

Our highly experienced, multidisciplinary team has performed 20 liver transplants in 20 pediatric patients over the last 4 years, with 95 percent patient survival.  This patient population included 6 recipients of live-donor grafts (4 of them under 1 year of age at transplant) and 2 split-liver transplant recipients.  My colleagues in transplant surgery, John Fung, MD, and Charles Miller, MD, have several decades of cumulative experience in pediatric and adult liver transplantation, including LDLT.  Pediatric hepatologists Vera Hupertz, MD, a skilled clinician and wonderful pediatrician, and Kadakkal Radhakrishnan, MD, an expert in pediatric metabolic liver disease, are key to our team's success.

An institution-wide team

In the Pediatric ICU, our intensivists offer an extraordinarily high level of coverage pre- and post-transplant, with an experienced board-certified pediatric intensivist on site 24 hours a day, seven days a week.  This translates into excellent clinical outcomes for children in their care.  When babies require transplantation, our adult anesthesiologists work in tandem with dedicated Children's Hospital anesthesiologists.  Rounding out our Pediatric Liver Transplant team are experienced pathologists, infectious disease specialists, radiologists and psychiatrists.  Through it all, dedicated pediatric transplant coordinators and social workers ensure prompt communication and a streamlined transplant process.

We welcome the opportunity to work with you to offer any infant, child or teen with end-stage liver disease an increased chance for long-term survival.