Vipul Gautam , Phani K. Nekarakanti , Vikram Kumar , Dibya J. Das , Shahnawaz Bashir , Shweta A. Singh , Subhash Gupta
{"title":"存活一年后的儿童活体肝移植受者的长期预后","authors":"Vipul Gautam , Phani K. Nekarakanti , Vikram Kumar , Dibya J. Das , Shahnawaz Bashir , Shweta A. Singh , Subhash Gupta","doi":"10.1016/j.jceh.2025.102631","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 102631"},"PeriodicalIF":3.3000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term Prognosis in Pediatric Living Donor Liver Transplant Recipients Who Have Survived the First Year of Surgery\",\"authors\":\"Vipul Gautam , Phani K. Nekarakanti , Vikram Kumar , Dibya J. Das , Shahnawaz Bashir , Shweta A. Singh , Subhash Gupta\",\"doi\":\"10.1016/j.jceh.2025.102631\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":15479,\"journal\":{\"name\":\"Journal of Clinical and Experimental Hepatology\",\"volume\":\"15 6\",\"pages\":\"Article 102631\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical and Experimental Hepatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0973688325001318\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical and Experimental Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0973688325001318","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Long-term Prognosis in Pediatric Living Donor Liver Transplant Recipients Who Have Survived the First Year of Surgery
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.