European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children
Corresponding Author
Jean de Ville de Goyet
Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
Correspondence
Jean de Ville de Goyet, Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, ISMETT, Via Ernesto Tricomi, 5, 90127 Palermo, Italy.
Email: [email protected]
Search for more papers by this authorUlrich Baumann
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
European Liver and Intestine Transplant Association, Padua, Italy
Search for more papers by this authorVincent Karam
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorRené Adam
European Liver and Intestine Transplant Association, Padua, Italy
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorSilvio Nadalin
Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
Search for more papers by this authorRaymond Reding
Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
Search for more papers by this authorSophie Branchereau
Service de Chirurgie Viscérale Pédiatrique Bicêtre University Hospital, Faculty of Medicine Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
Search for more papers by this authorDarius Mirza
Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorJürgen L. Klempnauer
Klinik für Viszeral und Transplantations-chirurgie, Hannover Medical School, Hannover, Germany
Search for more papers by this authorLutz Fischer
Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorPiotr Kalicinski
Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorMichele Colledan
Università degli studi di Milano Bicocca, ASST Giovanni XXIII, Department of Organ Failure and Transplantation, Bergamo, Italy
Search for more papers by this authorManuel Lopez Santamaria
Pediatric Surgery Department, Hospital Infantil Universitario ‘‘La Paz,”, Madrid, Spain
Search for more papers by this authorRuben H. de Kleine
Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Search for more papers by this authorChristophe Chardot
Service de Chirurgie Pediatrique, Hôpital Necker Enfants Malades, Paris, France
Search for more papers by this authorSezai Yilmaz
Liver Transplantation Institute, Inonu University, Malatya, Turkey
Search for more papers by this authorMurat Kilic
Liver Transplant Program, Izmir Kent Hospital, Izmir, Turkey
Search for more papers by this authorOlivier Boillot
Pediatric Liver Transplant Surgery, Hôpital Edouard Herriot, Lyon, France
Search for more papers by this authorFabrizio di Francesco
Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
Search for more papers by this authorWojciech G. Polak
European Liver and Intestine Transplant Association, Padua, Italy
Erasmus MC, Transplant Institute, Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
Search for more papers by this authorHenkjan J. Verkade
European Liver and Intestine Transplant Association, Padua, Italy
Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hospital, Groningen, the Netherlands
Search for more papers by this authorfor the European Liver, Intestine Transplant Association
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorCorresponding Author
Jean de Ville de Goyet
Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
Correspondence
Jean de Ville de Goyet, Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, ISMETT, Via Ernesto Tricomi, 5, 90127 Palermo, Italy.
Email: [email protected]
Search for more papers by this authorUlrich Baumann
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
European Liver and Intestine Transplant Association, Padua, Italy
Search for more papers by this authorVincent Karam
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorRené Adam
European Liver and Intestine Transplant Association, Padua, Italy
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorSilvio Nadalin
Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
Search for more papers by this authorRaymond Reding
Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
Search for more papers by this authorSophie Branchereau
Service de Chirurgie Viscérale Pédiatrique Bicêtre University Hospital, Faculty of Medicine Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
Search for more papers by this authorDarius Mirza
Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Search for more papers by this authorJürgen L. Klempnauer
Klinik für Viszeral und Transplantations-chirurgie, Hannover Medical School, Hannover, Germany
Search for more papers by this authorLutz Fischer
Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorPiotr Kalicinski
Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
Search for more papers by this authorMichele Colledan
Università degli studi di Milano Bicocca, ASST Giovanni XXIII, Department of Organ Failure and Transplantation, Bergamo, Italy
Search for more papers by this authorManuel Lopez Santamaria
Pediatric Surgery Department, Hospital Infantil Universitario ‘‘La Paz,”, Madrid, Spain
Search for more papers by this authorRuben H. de Kleine
Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Search for more papers by this authorChristophe Chardot
Service de Chirurgie Pediatrique, Hôpital Necker Enfants Malades, Paris, France
Search for more papers by this authorSezai Yilmaz
Liver Transplantation Institute, Inonu University, Malatya, Turkey
Search for more papers by this authorMurat Kilic
Liver Transplant Program, Izmir Kent Hospital, Izmir, Turkey
Search for more papers by this authorOlivier Boillot
Pediatric Liver Transplant Surgery, Hôpital Edouard Herriot, Lyon, France
Search for more papers by this authorFabrizio di Francesco
Department for the Treatment and Study of Pediatric Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy
Search for more papers by this authorWojciech G. Polak
European Liver and Intestine Transplant Association, Padua, Italy
Erasmus MC, Transplant Institute, Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
Search for more papers by this authorHenkjan J. Verkade
European Liver and Intestine Transplant Association, Padua, Italy
Department of Pediatrics, University Medical Center Groningen, University of Groningen, Hospital, Groningen, the Netherlands
Search for more papers by this authorfor the European Liver, Intestine Transplant Association
European Liver Transplant Registry, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, Université Paris-Sud, Inserm U 935, Villejuif, France
Search for more papers by this authorJean de Ville de Goyet, Ulrich Baumann, Vincent Karam, and Henkjan J. Verkade contributed equally for first authorship.
For the complete list of contributing centers, see Supporting Information B.
Funding information
The present work did not receive any external financial or nonfinancial support. ELTR is supported by unrestricted educational grants from Astellas, Institut Georges Lopez, Novartis, Sandoz, and Chiesi, with logistical support from the Paul Brousse Hospital (Assistance Publique–Hôpitaux de Paris) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition
Abstract
Background and Aims
The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.
Approach and Results
Over a 50-year period (1968–2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000–2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found.
Conclusions
Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
CONFLICT OF INTEREST
The authors declare there is no conflict of interest concerning this manuscript.
Supporting Information
| Filename | Description |
|---|---|
| hep32223-sup-0001-FigS1.tifTIFF image, 1.7 MB | Supplementary Material |
| hep32223-sup-0002-FigS2.tifTIFF image, 2.6 MB | Supplementary Material |
| hep32223-sup-0003-FigS3.tifTIFF image, 3.8 MB | Supplementary Material |
| hep32223-sup-0004-FigS4.tifTIFF image, 2.7 MB | Supplementary Material |
| hep32223-sup-0005-FigS5.tifTIFF image, 18 MB | Supplementary Material |
| hep32223-sup-0006-FigS6.tifTIFF image, 16.2 MB | Supplementary Material |
| hep32223-sup-0007-FigS7.tifTIFF image, 2.6 MB | Supplementary Material |
| hep32223-sup-0008-FigS8.tifTIFF image, 1.5 MB | Supplementary Material |
| hep32223-sup-0009-FigS9.tifTIFF image, 7.5 MB | Supplementary Material |
| hep32223-sup-0010-FigS10.tifTIFF image, 13.7 MB | Supplementary Material |
| hep32223-sup-0011-FigS11.tifTIFF image, 55.5 MB | Supplementary Material |
| hep32223-sup-0012-FigS12.tifTIFF image, 4.4 MB | Supplementary Material |
| hep32223-sup-0013-FigS13.tifTIFF image, 5.9 MB | Supplementary Material |
| hep32223-sup-0014-FigS14.tifTIFF image, 9.7 MB | Supplementary Material |
| hep32223-sup-0015-FigS15.tifTIFF image, 2.6 MB | Supplementary Material |
| hep32223-sup-0016-FigS16.tifTIFF image, 2.3 MB | Supplementary Material |
| hep32223-sup-0017-FigS17.tifTIFF image, 3.2 MB | Supplementary Material |
| hep32223-sup-0018-FigS18.tifTIFF image, 2.7 MB | Supplementary Material |
| hep32223-sup-0019-FigS19.tifTIFF image, 3.9 MB | Supplementary Material |
| hep32223-sup-0020-FigS20.tifTIFF image, 2.8 MB | Supplementary Material |
| hep32223-sup-0021-FigS21.tifTIFF image, 15.7 MB | Supplementary Material |
| hep32223-sup-0022-FigS22.tifTIFF image, 39.5 MB | Supplementary Material |
| hep32223-sup-0023-TableS1.docxWord 2007 document , 14.1 KB | Supplementary Material |
| hep32223-sup-0024-TableS2.docxWord 2007 document , 14.6 KB | Supplementary Material |
| hep32223-sup-0025-Supinfo1.docxWord 2007 document , 39.3 KB | Supplementary Material |
| hep32223-sup-0026-Supinfo2.docxWord 2007 document , 21.9 KB | Supplementary Material |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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