First Report of Long-term Outcomes of 700 Pediatric Liver Transplants From India.

Background: Acceptance of pediatric liver transplantation (PLT) in this part of the world has been slow because of a number of considerations, including those of cost, infections, and the nonavailability of expertise. Despite several obstacles, PLT has seen impressive growth in the recent years. Against a backdrop of this changing landscape of PLT in India, we present our experience of performing 700 PLT over a period of 13 y.

Methods: All 700 children (<18 y old) who underwent PLT from January 2011 to February 2024 were included in the study. Children were grouped in to group 1 (<5 kg), group 2 (5-10 kg) and group 3 (>10 kg) and survival analysis was performed. The outcomes of PLT performed over the first 7 y were compared with those of the next 6 y, with the aim to present any learning curve/teething troubles that could have presented while setting up the unit.

Results: The overall 90-d, 1-, 5-, and 10-y survivals were 94.2%, 90.4%, 86%, and 85.4%, respectively. The median (interquartile range) follow-up of the entire cohort was 65 mo (16-96 mo). There was no statistically significant difference in survival between the 3 weight-based groups or between the 2 eras.

Conclusions: We present the first report of long-term survival of the largest series of PLT from an emerging nation. Remarkably, with increasing numbers of liver transplantation being performed in the region over the past decade, the focus of care has now shifted from achieving early survival after liver transplantation to long-term follow-up.