Long-term Prognosis in Pediatric Living Donor Liver Transplant Recipients Who Have Survived the First Year of Surgery

Abstract

Background

Understanding long-term pediatric living donor liver transplant (LDLT) outcomes is crucial for families when consenting to it. This study focussed on pre-liver transplant (LT) clinical parameters, surgical procedures, delayed complications, follow-up challenges, and long-term prognosis within a living-donor program in a developing country.

Methods

This single-center retrospective study was carried out using a prospectively maintained database spanning from September 2006 to January 2023. The study included all pediatric LT (pLT) recipients, aged 1 month to 17 years, who survived for more than a year following LT.

Results

During the study, 480 pLTs were performed, with 448 (93.3%) children surviving beyond one year. Of 448 pLT recipients, 358 with adequate follow-up data formed the study cohort for long-term outcomes, while 90 with poor medication adherence and/or insufficient follow-up were analyzed separately as a noncompliant group. The majority (232,65%) of patients supplemented physical outpatient visits with online follow-up consultations via email and other online platforms. Twenty-three percent necessitated intervention within three-months of the surgery; however, it had no impact on occurrence of late complications or overall survival (P = 0.398). The primary cause of noncompliance was socioeconomic factors, which contributed to an increased incidence of chronic rejection in this group (12/90, 13.3%). Out of 358 compliant children, 30 died and 23 survived following late radiological or surgical intervention, while the remaining 305 had an uneventful long-term course with a median follow-up of 62 (IQR:31–112) months. The life table showed survival probabilities of 95%, 93%, 91%, and 72.4% at 3, 5, 10, and 15 years, respectively. Pediatric end-stage liver disease (PELD) score and post-LT portal vein thrombosis (PVT) were independent prognostic factors for long-term survival.

Conclusion

Pediatric LDLT yields favorable long-term outcomes, especially in 1-year survivors. Online follow-ups are beneficial in developing countries. Pre-LT PELD score and post-LT PVT help assess risk and optimize care.