Pediatric Surgery & Organs Transplantation
Children's Memorial Health Institute
Liver histopathology in long term follow-up after pediatric AB0i liver transplantation - single center experience
Małgorzata Markiewicz-Kijewska1, Sylwia Szymanska2, Joanna Teisseyre1, Marek Szymczak1, Piotr Kalicinski1.
1Pediatric Surgery & Organs Transplantation, Children's Memorial Health Institute, Warsaw, Poland; 2Pathomorphology, Children's Memorial Health Institute, Warsaw, Poland
Introduction: Liver transplantation (LT) has become a routine treatment for children with liver failure, however due to organ shortage or urgency of transplantation marginal donors are more widely accepted including donors with incompatible blood groups. The aim of our study was to assess liver histopathology of the AB0i grafts taken after long term follow-up from pediatric recipients. We performed retrospective analysis of liver specimens after ABOi liver transplantation for: liver fibrosis, inflammation, acute or chronic rejection.
Material and Methods: Between 1997 and 2016, 74 children aged 0,06-18,0 years (mean 5,09 yrs) received 75 ABOi grafts. 47 transplants were performed urgently and 20 electively. 44 liver transplantations were from living related donors, and 30 from deceased donors. Primary immunossupresion consisted mostly on quadruple therapy (antiCD25Ab, tacrolimus, mycophenolan mofetil and steroids). Late elective liver biopsies (more than 2 yrs after LT) were done in 34 children. Patients were divided into 2 groups: group 1 - children <2 y at LT and group 2 – children > 2 yrs at time of LT.
Results: The actual follow up of 34 patients is 2,34 – 17,3 years (mean 8,68 years, median 9 yrs). In group 1 (26 children) biopsies were performed between 2,23-11,39 years after LT (median 6,98 years). In group 2 (8 children) biopsies were taken between 2,03-12,93 years after LT (median 3,17 years). In group 1 almost normal liver specimens were found in 15/26 pts (57,6%), compared to 4/8 pts (50%) from group 2. One patient with cirrhosis in liver biopsy from group 2 was retransplanted. Results are shown in table.
Conclusions: Although clinical results in AB0i liver transplantation in children is quite good, in signifficant number of recipients various pathomorphological changes can be found in graft biopsies performed more than 2 years after LT. It seems that children transplanted with AB0i liver grafts in younger age present less advanced fibrosis than children older than 2 yrs at the time of LT, but small groups are compared. This study supports the need for protocol liver biopsies in this group of patients, which may indicate immunosuppression modifications.
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