Liver Transplantation in Childhood-Disputable Indications for Retransplantation in the Adulthood

Background: A 25-year retrospective analysis of pediatric liver transplantations after transition to the adulthood service was carried out with the special emphasis on patient’s survival, differences in survival related to age, gender, type of donation (deceased vs living), transplantation technique, type of biliary anastomosis and indications for retransplantation. A few controversial indications for retransplantation were discussed in more detail.

Material and methods: A group of 39 pediatric recipients were analyzed using current data and data provided by the national transplant registry. Survival was censored at 25 years of observation. Kaplan-Meyer cumulative mortality was calculated; statistical significance of survival was analysed using log-rank test.

Results: The probability of 25-year survival in the study group was 75%. A course without complications was recorded only in 12.8% of recipients. Neither sex, age at transplant, type of transplantation technique, type of biliary anastomosis nor the type of donation (deceased vs. living) influenced survival. Retransplantation was considered in 30% of pediatric recipients and performed in 12.8% of them.

Conclusions: Major indication for retransplantation was recurrent sclerosing cholangitis. Transplants were refused by noncompliant recipients who developed chronic rejection and graft loss. Vascular complications such as diffuse portal vein thrombosis make decisions for retransplantation the most difficult and controversial.