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Long-term survival after liver transplantation in children with metabolic disorders

Authors

  • Liise K. Kayler,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Robert M. Merion,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Samuel Lee,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1,2 Randall S. Sung,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1,3 Jeffrey D. Punch,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Steven M. Rudich,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Jeremiah G. Turcotte,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Darrell A. Campbell Jr,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • 1 Ronald Holmes,

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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  • and 4 John C. Magee 1

    1. Departments of 1Surgery and
      4Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA,
      2Department of Surgery, Hallym University, Seoul, Korea,
      3Department of Surgery, Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA
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John C. Magee, MD,
Department of Surgery, University of Michigan Health System, 2926 Taubman Center, PO Box 0331, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0331, USA
Tel.: 734-936-9623
Fax: 734-763-3187
E-mail:mageej@umich.edu

Abstract

Abstract:Background: Liver transplantation for inherited metabolic disorders aims to save the patient's life when the disorder is expected to progress to organ failure, and to cure the underlying metabolic defect. Methods: We retrospectively analyzed 146 pediatric liver transplants (28 metabolic; 118 non-metabolic) performed between 1986 and 2000. Results: Twenty-eight transplants were performed in 24 children with metabolic disease (8 females; 16 males; age range 3 months to 17 yr). Indications included α−1-antitrypsin deficiency (n = 8), two cases each of hyperoxaluria type 1, Wilson's disease, hereditary tyrosinemia type I, citrullinemia, methylmalonic acidemia, and one case each of propionic acidemia, Crigler–Najjar syndrome type I, neonatal hemachromatosis, hemophilia B, Niemann–Pick disease type B, and cystic fibrosis. Eighteen transplants were whole organ grafts and 10 were lobar or segmental. Auxiliary liver transplants were performed in two patients and three received combined liver-kidney transplants. There were three deaths from sepsis, two from chronic rejection, and one from fulminant hepatitis. Seven of 10 patients currently of school age are within 1 yr of expected grade and three who had pretransplant developmental delay have remained in special education. Actuarial survival rates at 5 and 10 yr are 78% and 68%, respectively, with mean follow-up in excess of 5 yr. These results compare favorably to 100 pediatric patients transplanted for non-metabolic etiologies (65% and 61%, respectively) (p= NS). Conclusions: Pediatric liver transplantation for metabolic disorders results in excellent clinical and biochemical outcome with long survival and excellent quality of life for most recipients.

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