Pediatric liver transplantation in Iran: evaluation of the first 50 cases

LT is nowadays accepted as the definitive therapy for end-stage liver disease. We report our experiences with pediatric LT using grafts from living related and DD. From April 1999 to March 2006, 50 infants and children who underwent LT were studied for pretransplantation status, medical and surgical complications and survival rate. There were 33 (66%) boys and 17 (34%) girls. The mean age of patients was 9.9 +/- 4.8 yr (range: 0.9-17.7) with a mean weight of 33.4 +/- 18.4 kg (range: 7.5-80). The main indications were cryptogenic cirrhosis (30%), autoimmune cirrhosis (24%), followed by biliary atresia (22%), Wilson disease (14%), progressive familial intrahepatic cholestasis (4%), fulminant hepatitis (4%) and tyrosinemia (2%). We used living-related donor in 14 (28%) and split liver in 5 (10%) cases and other patients received whole liver from DD. The mean follow-up of patients was 24.7 +/- 22.6 months (range: 1-72). The main postoperative complications were acute cellular rejection (44%) and infections (30%), whereas chronic rejection was seen in 26% of cases. The mortality rate was 24%. Overall mean survival (76% alive) was 63.5 +/- 5.7, 95% CI: 52.3-74.6. Our results demonstrate that pediatric LT is a feasible undertaking in Iran. Organ shortage in our area led to liberal use of living related and split liver techniques. The overall results of the pediatric LT in Iran are encouraging.