Liver Transplantation during Infancy Provides Similar Overall Results and Might Enhance Prope/Operational Tolerance in the Long Term

Bourdeaux, Christophe;De Magnée, Catherine;Sokal, Etienne;Reding, Raymond;Smet, Francoise;et.al.
(2010) 16th Annual Congress of the International-Liver-Transplantation-Society — Location: Hong Kong (Peoples R China) (16.June.2010)

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  • Bourdeaux, ChristopheUCLouvain
    Author
  • De Magnée, CatherineUCLouvain
    Author
  • Sokal, EtienneUCLouvain
    Author
  • Reding, RaymondUCLouvain
    Author
  • Pire, AuroreUCLouvain
    Author
  • Janssens, MagdaUCLouvain
    Author
  • Smet, FrancoiseUCLouvain
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Abstract
In our recent liver transplant (LT) experience, as much as 38% of patients were transplanted during infancy (<1yr). We hypothesized that immunological immaturity observed in infants might result in lower rejection rates and enhanced allograft tolerance. Patients and Methods: 196 pediatric recipients of a primary LT, transplanted between 04/1999 and 06/2007 under tacrolimusbased immunosuppression, were reviewed. A subpopulation of 168 children became long-term survivors (>1 yr post-LT), with a documented median follow-up of 6.0 yrs. In these, prope tolerance was defi ned as tacrolimus monotherapy, with mean trough blood levels 4ng/ml during the preceding year, combined with normal liver tests; operational tolerance was defi ned as stable immunosuppression withdrawal (>1yr). Results: Among the 75 children transplanted as infants, the 1- and 5-yr patient survival rates were 97% and 93%, versus 93% and 92% for children transplanted beyond 1 year of age, respectively (NS); the corresponding graft survival rates were 95% and 90%, versus 88% and 84% (NS). At 5 yrs, no signifi cant difference was observed in term of hepatic artery thrombosis rate (<1yr: 7%; >1yr: 4%, NS) or biliary complication rate (<1yr: 16%; >1yr: 22%, NS). Only the 5-yr rate of portal vein complication was signifi cantly higher in infants (<1yr: 12%; >1yr: 4%, p=0.01). Regarding the immunological issues, the 5 yr rate of acute rejection was comparable in both groups (<1yr: 66%; >1yr: 61%, NS); similarly, no difference was found for chronic rejection (<1yr: 1%; >1yr: 4%, NS). Among the 168 long-term survivors post-LT, 38/68 recipients transplanted as infants became prope/operationally tolerant (56%), compared to 41/100 children transplanted beyond 1 yr of age (41%) (p=0.058). Moreover, steroid avoidance and living related LT were both signifi cantly associated with later occurrence of a prope/operational tolerance (p=0.011 and p=0.01, respectively). Conclusions: (1) No signifi cant impact of recipient age on overall patient/ graft outcome could be evidenced; (2) transplanted infants seemed to have increased rate of portal complications, possibly related to portal vein hypoplasia; (3) despite similar rejection rates, infants showed a trend toward enhanced allograft tolerance in the long-term.
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Bourdeaux, C., De Magnée, C., Sokal, E., Reding, R., Pire, A., Janssens, M., & Smet, F. (2010). Liver Transplantation during Infancy Provides Similar Overall Results and Might Enhance Prope/Operational Tolerance in the Long Term. Liver Transplantation, 16(6), S116-S116. https://hdl.handle.net/2078.5/147056 (Original work published 2010)