FOLLOW-UP OF 25 CHILDREN WHO UNDERWENT LIVER-TRANSPLANTATION

Liver transplantation is the only available treatment for liver disease with irreversible and progressively downhill course both in adults and in children. At present, although there is not an Italian pediatric liver transplantation program, an increasing number of children are resorting to this therapy both in Italian centres for adults and in foreign pediatric centres. Clinical management of these patients in pediatric wards before and after discharge from liver transplantation centres may arise several challenging difficulties. We therefore report our experience on 25 children (13 males) who underwent liver transplantation and have been followed-up in our Department for a mean period of 20.0 months (range 3-49 months). Before transplantation most patients received liposoluble vitamins, medium chain triglycerides oil, nutritional caloric support, and completed immunization programs. Children underwent liver transplantation at Centres of Bruxelles, St Luc Hospital (n = 11), Paris-Bicetre (n = 4), Paris-Villejuif (n = 1), Marseille-La Timone (n = 1), Cambridge-Addenbrooke's Hospital (n = 1) and at the Centre of Milan-Policlinico (n = 7). The mean period of stay in the transplantation centres was 80 days. Four patients died within the first two months after liver transplantation. At present, liver function tests are normal in all 21 living patients. Sixteen of them follows double immunosoppressive therapy based on steroids and Cyclosporin A (assayed in the blood by polarized fluorescence - TDX). Five children follows a triple drug regimen including Azatioprine. Any of the patients developed severe hepatic or vascular drug induced toxicity during the mean and long term follow-up at our institution. One patient developed neurotoxicity, one nephrotoxicity, two severe Cytomegalovirus infection, two Chickenpox. Five patients had mild rejection. All these complications resolved with appropriate medical care. Two patients developed a Cryptosporidium asymptomatic infection, two others Giardiasis with intestinal symptoms in one of them, and one pulmunar tuberculosis. Two patients developed antibodies anti hepatitis C virus with fluctuating values of serum aminotransferases. Clinical status and life style are good in all. At present, 10 additional patients are waiting for liver transplantation.