Our Summary

The European Liver Transplant Registry (ELTR) has been gathering information on liver transplants in Europe since 1968. In this study, they looked at data from over 16,000 liver transplants performed in over 14,000 children across 133 transplant centers over the last 50 years. The information was divided into three time periods for analysis: before 2000, 2000-2009, and since 2010.

The researchers found that the use of living donors for the transplants had increased over time. Of the three groups, 7% (group A), 23% (group B), and 39% (group C) of the transplants were from living donors.

Additionally, the survival rate of the transplanted liver (or graft) has also improved. In group A, the 5-year survival rate was 65%, but it increased to 75% in group B and 79% in group C. The average time a graft lasts (half-life) was about 31 years in general, but for children who survived the first year after the transplant, the graft half-life was 41 years.

However, the study found that teenagers have a higher rate of graft loss than children under 12, similar to young adults. But there’s no evidence showing that graft loss speeds up after 18 years old.

In conclusion, liver transplants in children have proven to be highly effective in treating severe liver disease. Livers that survive the first year after transplant have a life expectancy similar to the average human lifespan. The timing of the transplant, either before or after puberty, might affect the long-term success rate in children. More research is needed to better understand the benefits of transplantation for young children, the role of the recipient’s health versus the age of the graft, and the risks as children transition into adulthood.

FAQs

  1. What is the European Liver Transplant Registry and how long has it been collecting data?
  2. How has the use of living donors for liver transplants changed over the years according to the data collected by the ELTR?
  3. What is the survival rate of liver grafts in children and how does it compare to the graft survival rate in teenagers and young adults?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver transplant is to closely follow post-operative care instructions, including taking medications as prescribed, attending follow-up appointments, and making necessary lifestyle changes to ensure the success of the transplant. It is also important to communicate any concerns or changes in health to the medical team promptly.

Suitable For

Patients who are typically recommended for liver transplant include those with severe liver disease in infants and children, as well as teenagers and young adults. The efficacy of pediatric liver transplantation has been shown to be high, with improvements in graft survival rates over the years. Living donors are increasingly being used for liver transplants, and the overall 5-year graft survival rate has improved significantly. It is important to consider the timing of liver transplantation, as outcomes may be lower in children who undergo transplantation before or after puberty. Further studies are needed to better understand the long-term outcomes and risks associated with liver transplantation in different age groups.

Timeline

Before liver transplant:

  • Patient is diagnosed with severe liver disease
  • Patient undergoes medical evaluation to determine eligibility for transplant
  • Patient is placed on a waiting list for a suitable donor liver
  • Patient may experience worsening symptoms and complications of liver disease
  • Patient may undergo medical treatments to manage symptoms and complications

After liver transplant:

  • Patient undergoes surgery to receive a new liver from a deceased or living donor
  • Patient is closely monitored in the hospital for complications and recovery
  • Patient may experience side effects of immunosuppressive medications to prevent organ rejection
  • Patient undergoes regular follow-up appointments and monitoring to assess liver function and overall health
  • Patient may experience improvements in symptoms and quality of life post-transplant
  • Patient may need to make lifestyle changes to support overall health and wellbeing
  • Patient may need ongoing medical care and support for the rest of their life to ensure the success of the transplant.

What to Ask Your Doctor

  1. What is the success rate of liver transplant procedures in children, particularly in terms of graft survival and long-term outcomes?

  2. What are the potential risks and complications associated with liver transplant surgery in children?

  3. How does the use of living donors compare to deceased donors in terms of outcomes for pediatric liver transplant patients?

  4. How does the age of the recipient, specifically before or after puberty, impact long-term outcomes following a liver transplant?

  5. What is the average half-life of a liver transplant graft in pediatric patients who survive the first year post-transplant?

  6. Are there any specific factors or conditions that may affect the success of a liver transplant in children?

  7. How does the late annual graft loss rate in teenagers compare to younger children and young adults who undergo liver transplant surgery?

  8. What kind of follow-up care and monitoring will be required for a child who undergoes a liver transplant?

  9. Are there any lifestyle changes or restrictions that the child will need to adhere to post-transplant to ensure the success of the procedure?

  10. What ongoing support and resources are available for pediatric liver transplant patients and their families?

Reference

Authors: de Ville de Goyet J, Baumann U, Karam V, Adam R, Nadalin S, Heaton N, Reding R, Branchereau S, Mirza D, Klempnauer JL, Fischer L, Kalicinski P, Colledan M, Lopez Santamaria M, de Kleine RH, Chardot C, Yilmaz S, Kilic M, Boillot O, di Francesco F, Polak WG, Verkade HJ; European Liver, Intestine Transplant Association. Journal: Hepatology. 2022 Mar;75(3):634-645. doi: 10.1002/hep.32223. Epub 2021 Dec 16. PMID: 34724224