Pediatric Liver Transplantation in the Shiraz Transplant Center
S.-A. Malek-Hosseini, H. Salahi, A. Bahador, M.-H. Imanieh, A. Mehdizadeh, A. Razmkon,
M.-H. Anbardar, and S. Gholami
L IVER TRANSPLANTATION was performed for the
first time in 1963, but for more than two decades it
remained an experimental method with low success and high
mortality rates.1,2 Nowadays, with new surgical methods and
new immunosuppressive drugs, liver transplantation is ac-
cepted as the best and sometimes even the only way to cure
some life-threatening liver diseases.3,4 It is a successful and
useful therapy for children with chronic or end-stage liver
disease and those with a variety of extrahepatic metabolic
diseases can be corrected by liver replacement.5
Liver transplantation has been done throughout Iran and
some neighboring countries exclusively in our center for 12
years. Potential recipients from all over the country or neigh-
boring countries are selected for the waiting list based on the
established indications for liver transplantation. The objective
of this study was to analyze a single center’s 12-year experience
with 24 pediatric patients with end-stage liver diseases.
MATERIALS AND METHODS
The first 150 consecutive liver transplantations were performed
between 14 April 1993 and 15 February 2005 in Shiraz (Southern
Iran) Organ Transplant Center. We evaluated the 24 pediatric liver
transplantations retrospectively, using the liver transplantation
database with a minimum follow-up period of 6 months. To collect
data, we used new software from the Persian Network for Organ
Transplant (PNOT), which was prepared in the Shiraz center and
included all identifying laboratory data, imaging reports, and
consultations for every patient. We evaluated the 1-, 2-, and 3-year
patient survival rates, the source of the transplanted organ, whether
it was from a living or cadaveric donor, and postoperative compli-
cations till now. All data were recorded in Microsoft Excel 2003
and SPSS 10 software and analyzed by this software.
RESULTS
Among 24 consecutive recipients, 75% were male and 25%
were female. The average age of the recipients was 9.7 ⫾ 4.5
years (range, 0.92–15 years). Fifteen patients had a full-size
cadaveric transplant; 9 patients received a graft from a living
donor. Only two cases had split-liver transplantation. The
operative procedure was performed in a standard manner
using a duct-to-duct anastomosis in 68% of the cases; the
piggyback technique was utilized in 90%, and venovenous
bypass in the rest. All cases were first transplantations. The
immunosuppressive regimen included Cellcept, cyclosporine,
and methylprednisolone. Major causes of liver failure included
0041-1345/06/$–see front matter
doi:10.1016/j.transproceed.2005.12.104
594
cryptogenic cirrhosis (41.6%), autoimmune hepatitis (20.8%),
biliary atresia (20.8%), neonatal cirrhosis (12.5%), and biliary
hypoplasia (4.3%). Rejection occurred in 27% of cases once
and 8% twice. The most common short-term complications
included respiratory complications (12%), neurologic compli-
cations (10%), and biliary complications (10%). Long-term
complications included rejection (9%), renal failure (6%), and
death (15%). The 1-, 2-, and 3-year patient survival rates were
92%, 89%, and 85%, respectively.
DISCUSSION
The success of pediatric orthotopic liver transplantation has
improved greatly since its widespread application in the
1980s. No group has benefited more from this than infants
younger than 1 year.6 The perfect performance of the proce-
dure, reasonable immunosuppressive regimen, and prevention
and prompt therapy of complications are the keys to achieve
satisfactory results. However, with timely recognition and
active intervention, a good outcome can be achieved.7 As the
Shiraz Transplant Center is the only established pediatric liver
transplant center in Iran, children are referred from all over
the country and this dislocation from social support services,
including family, friends, and the workplace, has major emo-
tional and financial implications.
Based on the analyzed data in this research study, and
considering similar research projects performed at other ma-
jor centers around the world, it can be concluded that al-
though only 12 years old, this only center in the country has
done well and is a great source of hope for the promotion of
science and health.
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From the Nemazee Hospital, Shiraz (Southern Iran) Organ
Transplant Center, Shiraz, Iran.
Address reprint requests to Ali Razmkon, PO Box 71455-166,
Shiraz, Iran. E-mail: ali.razmkon@gmail.com
© 2006 by Elsevier Inc. All rights reserved.
360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 38, 594 –595 (2006)
PEDIATRIC LIVER TRANSPLANTATION IN IRAN
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