European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

European Liver, Intestine Transplant Association (ELITA), Jean de Ville de Goyet*, Ulrich Baumann, Vincent Karam, René Adam, Silvio Nadalin, Nigel Heaton, Raymond Reding, Sophie Branchereau, Darius Mirza, Jürgen L Klempnauer, Lutz Fischer, Piotr Kalicinski, Michele Colledan, Manuel Lopez Santamaria, Ruben H de Kleine, Christophe Chardot, Sezai Yilmaz, Murat Kilic, Olivier BoillotFabrizio di Francesco, Wojciech G Polak, Henkjan J Verkade

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND & AIMS: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.

APPROACH & RESULTS: Over a 50 years period (1968 - 2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to 3 successive periods (A: before 2000, B: 2000 to 2009, and C: since 2010), studying donor and graft characteristics, and graft outcome. The use of living donors steadily increased from A to C [A: n=296 (7%), B: n=1131 (23%) and C: n=1985 (39%); P=0.0001]. Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p<0.0001), and to 79% in group C (B vs C, p<0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teen-agers is higher than children aged < 12 years, and similar to that of young adults. No evidence for accelerated graft loss after age 18 year was found.

CONCLUSIONS: Pediatric liver transplantation has reached a high efficacy as a cure, or treatment, for severe liver disease in infants and children. Grafts that survived the first year had a half-life time similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to re-visit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.

Original languageEnglish
Pages (from-to)634-645
Number of pages12
Issue number3
Early online date16-Dec-2021
Publication statusPublished - Mar-2022




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