Post-transplant complications in children with congenital cholestatic liver diseases
DOI:
https://doi.org/10.15574/PP.2025.4(104).6872Keywords:
orthotopic liver transplantation, pediatrics, biliary atresia, living donor, post-transplant complications, graft fibrosisAbstract
Orthotopic liver transplantation (OLT) remains the only radical treatment for end-stage liver failure in children with congenital cholestatic liver diseases. The main indications include biliary atresia, Alagille syndrome, and other inherited cholestatic syndromes. Despite advances in surgical techniques and postoperative care, the risk of early and late complications remains high, particularly in children weighing <10 kg.
Aim - to evaluate the incidence, structure, and timing of post-transplant complications in children with congenital cholestatic liver diseases after orthotopic liver transplantation (OLT), as well as to identify risk factors for their development.
Materials and methods. A retrospective single-center study was conducted on 54 children who underwent primary OLT for congenital cholestatic liver disease. The mean age at transplantation was 1.4±1.0 years, and the mean body weight was 17.9±14.4 kg. Transplants were performed from living related donors (88.9%) or deceased donors (11.1%), using left lateral segment, reduced, or monosegment grafts. Early complications were defined as those occurring within 90 days post-transplant, while late complications occurred after 90 days. Descriptive statistical analysis was applied.
Results. The most common indication was biliary atresia (81.5%). Early complications included acute graft rejection (40.7%), infectious complications (31.5%), and surgical or biliary complications (11.1% each). Late complications included graft fibrosis (59.3%), neurological complications (11.1%), metabolic/endocrine disorders (5.6%), and post-transplant mortality (3.7%). Overall patient survival exceeded 94%.
Conclusions. Orthotopic liver transplantation in children with congenital cholestatic liver diseases is safe and effective. Living related donors and tailored graft types allow transplantation even in children with low body weight. The significant risk of early and late complications highlights the need for long-term postoperative monitoring and multidisciplinary follow-up.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee. Written informed consent was obtained from all participants.
The authors declare that there is no conflict of interest.
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