Transplant Without Borders: Clinical Outcomes and Challenges in Transborder Living Donor Pediatric Liver Transplantation in Jordan.

IF 2.8 3区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics
Therapeutics and Clinical Risk Management Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S530639
Fareed Khdair Ahmad, Dima Abu Nasrieh, Mohammad Moazi Rwalah, Abdullah Ghanma, Yaser Rayyan, Yara Hamad, Tahani Ahmad, Saeed Mohammad
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Abstract

Purpose: To describe the clinical outcomes, complications, and logistical challenges of pediatric living donor liver transplantation (LT) in Jordanian children referred abroad, in the absence of a national transplant program.

Patients and methods: This retrospective study reviewed all pediatric cases referred to the Jordanian Center for Organ Transplantation (JCOT) for LT between 2019 and 2023. Data were collected from JCOT records and follow-up interviews with caregivers. Variables included patient demographics, indications for transplantation, donor-recipient relationships, post-operative complications, survival outcomes, and financial aspects.

Results: A total of 31 children were referred for LT, of whom 20 (64.5%) successfully underwent living donor liver transplantation abroad-primarily in Turkey-while 11 (35.5%) remained on the waiting list. Biliary atresia (25%) was the most common indication, followed by Alagille syndrome and progressive familial intrahepatic cholestasis (each 20%). Primary hyperoxaluria, Crigler-Najjar syndrome, and maple syrup urine disease were also observed. Parents were the most frequent donors (70%). The most common complications were bile duct leakage (35%), portal vein thrombosis (20%), and infections (15%). The 5-year post-transplant survival rate was 90%. Among the waiting list group, four children (36.4%) died before receiving a transplant. No children underwent transplantation for pediatric acute liver failure during the study period. The average cost per transplant covered by the Ministry of Health was $61,071, excluding out-of-pocket expenses borne by families.

Conclusion: This study highlights the feasibility and challenges of transborder pediatric liver transplantation in Jordan. While clinical outcomes for transplanted children were favorable, significant barriers remain, including delayed referrals, financial strain, and mortality among waitlisted patients. These findings underscore the urgent need to establish a national pediatric liver transplant program to improve timely access and long-term care for children with end-stage liver disease in Jordan.

无国界移植:约旦跨境儿童活体肝移植的临床结果和挑战。
目的:描述在缺乏国家移植计划的情况下,约旦儿童转介国外的儿童活体供肝移植(LT)的临床结果、并发症和后勤挑战。患者和方法:本回顾性研究回顾了2019年至2023年期间所有到约旦器官移植中心(JCOT)进行肝移植的儿科病例。数据收集自JCOT记录和对护理人员的随访访谈。变量包括患者人口统计学、移植指征、供体-受体关系、术后并发症、生存结果和经济方面。结果:共有31名儿童接受了肝移植,其中20名(64.5%)成功地在国外(主要是土耳其)接受了活体肝移植,而11名(35.5%)仍在等待名单上。胆道闭锁(25%)是最常见的适应症,其次是Alagille综合征和进行性家族性肝内胆汁淤积症(各占20%)。原发性高草酸血症、克里格勒-纳贾尔综合征和枫糖浆尿病也被观察到。父母是最常见的捐赠者(70%)。最常见的并发症是胆管渗漏(35%)、门静脉血栓形成(20%)和感染(15%)。移植后5年生存率为90%。在等候名单组中,有4名儿童(36.4%)在接受移植前死亡。在研究期间,没有儿童因急性肝衰竭而接受移植。卫生部支付的每次移植平均费用为61,071美元,不包括家庭自付费用。结论:本研究突出了约旦跨境儿童肝移植的可行性和挑战。虽然移植儿童的临床结果是有利的,但仍然存在重大障碍,包括延迟转诊、经济压力和等待患者的死亡率。这些发现强调了迫切需要建立一个国家儿童肝移植计划,以改善约旦终末期肝病儿童的及时获取和长期护理。
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来源期刊
Therapeutics and Clinical Risk Management
Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-
CiteScore
5.30
自引率
3.60%
发文量
139
审稿时长
16 weeks
期刊介绍: Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.
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