SUCCESSFUL LIVER-TRANSPLANTATION IN BABIES UNDER 1 YEAR

Objective-To review the outcome of liver transplantation in babies aged less than 1 year. Design-Prospective evaluation of survival, clinical complications, and nutritional and developmental status before and one year after liver transplantation. Setting-The Children's Hospital and Queen Elizabeth Hospital, Birmingham. Subjects-All 25 babies who received liver transplantation from january 1989 to December 1992 were included. Median age was 9 months and median weight was 7.0 kg. Seven babies were assessed but were not given transplants because they died while on the waiting list (two) or had severe extrahepatic disease (five). Results-24 babies had severe decompensated liver disease and 20 were severely malnourished despite nutritional support. Six babies received a whole liver graft and 19 received a reduction hepatectomy. Postoperative complications included primary nonfunction of the transplanted liver (one baby), hepatic artery thrombosis (two), biliary obstruction (seven), acute and chronic rejection (six), and sepsis (18). Three babies required a second transplant; all survived. Three babies, two of whom presented with fulminant hepatic failure, died. The overall actuarial survival rate (4 months to 4 years) is 88%. Review at 12 months showed a dramatic improvement in growth (p<0.001) and normal psychosocial development with good quality of life. Conclusion-The improvement in survival rates and quality of life in this group of very sick babies is related not only to the development of reduction hepatectomy but also to advances in medical and nursing expertise. Early referral for liver transplantation is justified even if babies are critically ill.