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Indian Pediatr 2018;55: 349-350 |
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Outcome of Pediatric Living Donor Liver Transplantation in
India
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Vikrant Sood and Seema Alam*
Department of Pediatric Hepatology, Institute of Liver
and Biliary Sciences, Vasant Kunj, New Delhi, India.
Email: * [email protected]
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We read with interest a recent article by Mohan, et al. [1] who
have summarized their experience of 200 pediatric living donor liver
transplantations in one of the largest series from the country. We would
like to highlight some issues with the study.
Authors have mentioned using Pediatric end stage
liver disease (PELD) scores (>10 for age <12 years), and Model for
end-stage liver disease (MELD) scores (>15 for age >12 years) for
listing for liver transplantation in patients with chronic liver disease
(CLD) as per Western guidelines [2]. This statement requires careful
interpretation as these scores are not at all meant to be used for
listing a patient or deciding the need of liver transplantation in an
individual patient. The above statement infers that a patient with a
PELD score of <10 or a MELD score of <15 would not be
listed irrespective of his/her clinical status. Quoting the same
guidelines, every CLD patient who develops worsening of hepatic
functions (intractable ascites, progressive encephalopathy,
uncorrectable coagulopathy and/or, recurrent infections; and not just
uncontrolled portal hypertension), mandates evaluation for liver
transplantation [2]. These severity scores are meant to be used only in
countries having proper organ allocation mechanisms for diseased donor
transplantation, and that too, only for deciding the priority and not
for listing. In resource-constrained settings, where a vast majority of
liver transplantations are living donor related, these scores have
limited practical utility, except for prognostication. Thus, using fixed
cut-offs for deciding need of liver transplantation in CLD is far from
being an ideal strategy.
Despite having a long study period of 13 years, vital
information on post transplant follow-up, including attrition/loss to
follow-up, drug compliance rates, renal outcomes is missing from the
reported study. Reasons for lower incidence of vascular complications,
any trend (if seen) in the incidence of complications over the study
period, and actual modifications in transplant protocols over the study
period (to improve the outcomes) require further clarification [3].
Also, predictors of morbidity and mortality, if studied in the study
cohort, would have added much needed information to the national
database [4,5].
References
1. Mohan N, Karkra S, Rastogi A, Dhaliwal MS,
Raghunathan V, Goyal D, et al. Outcome of 200 pediatric living
donor liver transplantation in India. Indian Pediatr. 2017;54:913-8.
2. Squires RH, Ng V, Romero R, Ekong U, Hardikar W,
Emre S, et al. Evaluation of the Pediatric Patient for Liver
Transplantation: 2014 Practice Guideline by the American Association for
the Study of Liver Diseases, American Society of Transplantation and the
North American Society for Pediatric Gastroenterology, Hepatology and
Nutrition. Hepatology. 2014;60:362-98.
3. Mali VP, Aw M, Quak SH, Loh DL, Prabhakaran K.
Vascular complications in pediatric liver transplantation;
single-center experience from Singapore. Transplant
Proc. 2012;44:1373-8.
4. Kasahara M, Umeshita K, Inomata Y, Uemoto
S; Japanese Liver Transplantation Society. Long-term outcomes of
pediatric living donor liver transplantation in Japan: An analysis of
more than 2200 cases listed in the registry of the Japanese Liver
Transplantation Society. Am J Transplant. 2013;13:1830-9.
5. Byun J, Yi NJ, Lee JM, Suh SW, Yoo T, Choi Y, et
al. Long term outcomes of pediatric liver transplantation
according to age. J Korean Med Sci. 2014;29:320-7.
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