Liver transplantation at Red Cross War Memorial Children's Hospital


Show simple item record Spearman, C W N McCulloch, M Millar, A J W Burger, H Numanoglu, A Goddard, E Gajjar, P Davies, C Muller, E McCurdie, FJ Kemm, D Cywes, S Rode, H Kahn, D 2017-07-07T09:29:16Z 2017-07-07T09:29:16Z 2006
dc.identifier.citation Spearman, C., McCulloch, M., Millar, A., Burger, H., Numanoglu, A., Goddard, E., Gajjar, P., Davies, C., Muller, E., McCurdie, F., Kemm, D., Cywes, S., Rode, H., & Kahn, D. (2006). Liver transplantation at Red Cross War Memorial Children's Hospital. South African Medical Journal, 96(9), 960.
dc.description.abstract The liver transplant programme for infants and children at Red Cross War Memorial Children’s Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. Patients and methods. Since 1987, 81 children (range 6 months - 14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. Results. Sixty patients (74%) survived 3 months - 14 years post transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) postliver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). Conclusion. Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.
dc.source South African Medical Journal
dc.title Liver transplantation at Red Cross War Memorial Children's Hospital
dc.type Journal Article en_ZA 2016-01-12T09:16:13Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Child and Adolescent Psychiatry en_ZA
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