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Renal function following liver transplantation for unresectable hepatoblastoma

Lee WS, Grundy R, Milford DV, Taylor CM, de Ville de Goyet J, McKiernan PJ, et al.

Pediatr Transplant, 2003 Aug;7(4):270-6.
PMID: 12890004

Combination of cyclosporine (CsA) and tacrolimus immunosuppression post-liver transplantation (LT) and the chemotherapeutic drugs used to treat hepatoblastoma (HB), are nephrotoxic. We aimed to determine the severity and duration of nephrotoxicity in children following LT for unresectable HB. We reviewed all children undergoing LT for unresectable HB at the Liver Unit, Birmingham Children's Hospital, UK, from 1991 to July 2000. Thirty-six children undergoing LT for biliary atresia, matched for age and sex, were selected as controls to compare pre- and post-LT renal function. Renal function was determined by estimation of glomerular filtration rate (eGFR) derived from plasma creatinine using Schwartz's formula. Twelve children with HB (mean age of diagnosis 33 months) who underwent LT (mean age 47 months) and 36 controls (mean age of LT 34 months) were studied. CsA was the main immunosuppressive drug used in each group. The median eGFR before, and at 3, 6, 12, 24 and 36 months after LT in HB group was significantly lower than controls (93 vs. 152, 66 vs. 79, 62 vs. 86, 66 vs. 87, 64 vs. 94, 53 vs. 90 mL/min/1.73 m2, respectively; 0.01 < p < 0.03). The reductions in the median eGFR of both the HB group and controls before and at 36 months after LT were 49 and 41%, respectively. At 36 months after LT, there was a trend for partial recovery of the eGFR in the controls but not in the HB group. Children who underwent LT for unresectable HB had renal dysfunction before transplantation that persisted for 36 months after LT.
High-dose chemotherapy with autologous stem cell transplantation in infants and young children with ependymoma: A 10-year experience with the Head Start II protocol

Rajagopal R, Foo JC, Jawin V, Qaddoumi I, Bouffet E

Pediatr Transplant, 2019 06;23(4):e13421.
PMID: 31012212 DOI: 10.1111/petr.13421
Are strict organ allocation systems fanning the illegal trade?

Khoo EJ

Pediatr Transplant, 2018 03;22(2).
PMID: 29314481 DOI: 10.1111/petr.13122
Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety

Kyaw L, Lai NM, Iyer SG, Loh DSKL, Loh SEK, Mali VP

Pediatr Transplant, 2022 Mar;26(2):e14187.
PMID: 34724594 DOI: 10.1111/petr.14187

PURPOSE OF THE SYSTEMATIC REVIEW: To determine the efficacy and safety of percutaneous trans-hepatic balloon and/or stent angioplasty (PTA) in the management of portal vein (PV) stenosis following paediatric liver transplantation.
METHODS: Articles were included from a systematic search of Medline, Embase, Cochrane CENTRAL, ClinicalTrials.gov and International Clinical Trials Registry from inception to the 29th of August 2020.
RESULTS: There were 213 paediatric liver recipients who underwent PTA for PV stenosis in 19 included studies published between 1991 and 2019. Balloon angioplasty was the initial treatment in the majority (n = 153). Primary stent placement (n = 34) was performed for elastic recoil, intimal tears and PV kinks and rescue stent placement (n = 14) for recurrent PV stenosis following primary balloon angioplasty. The technical success was 97.6%-100% overall, 97.6%-100% for balloon-angioplasty-only and 100% for primary stenting. The clinical success was 50%-100% overall, 50%-100% for balloon-angioplasty-only and 100% for primary stenting. Long-term PV patency was 50%-100% overall, 37.5%-100% for balloon-angioplasty-only and 100% for primary stenting. Primary balloon angioplasty was successful in 78% of the cases. Of the recurrent PV stenoses, 9% resolved with stent placement and one required a meso-Rex shunt. There was one re-transplantation without stenting. The complication rate was 2.6% for balloon-angioplasty-only (bleeding, liver abscess, 2 PV thromboses) and 5.9% for primary stenting (bleeding, stent-fracture). There was no procedure-related mortality.
CONCLUSION: Percutaneous transhepatic balloon angioplasty may be the initial management of portal vein stenosis in paediatric liver recipients. Stent placement may be a primary option in selected cases and a reliable rescue option for recurrent portal vein stenosis following balloon-angioplasty-only.
Pattern of Infection After Pediatric Liver Transplant and Its Associated Risk Factors

Tanimura S, Chuah SL, Shimizu S, Sakamoto S, Kasahara M, Nakagawa S

Pediatr Transplant, 2025 Feb;29(1):e70032.
PMID: 39837776 DOI: 10.1111/petr.70032

BACKGROUND: Liver transplantation has improved survival rates in pediatric patients with end-stage liver failure. However, post-liver transplant infection remains a threat to patient recovery. This study reported the frequency and patterns of infections after liver transplantation and identified factors related to the accuracy of fever source investigation.
METHOD: This is a single-center descriptive and retrospective study in the quaternary Pediatric Intensive Care Unit (PICU) in Japan. All pediatric patients who underwent liver transplantation from 2019 to 2021 were eligible. The patients were divided into two groups based on culture positivity: the positive culture group and the negative culture group.
RESULTS: A total of 152 pediatric patients were included in the study. The median age was 11 months, and 86% of cases underwent living donor liver transplantation. Among the 152 cases, 18% showed positive bacterial culture results. The timing of positive culture varied bimodally, with 34% occurring after postoperative day 15. Among the positive cultures, 84% were bacterial, and 20% were fungal. Factors associated with positive culture were analyzed, and as a result, re-laparotomy and a higher graft recipient weight ratio (GRWR) were identified as factors associated with infection.
CONCLUSIONS: We reported the frequency and patterns of infections in pediatric patients undergoing living donor liver transplantation and demonstrated that factors associated with positive culture were re-laparotomy and GRWR. This study provides important clinical data for infection management after liver transplantation.