Liver transplantation at Red Cross War Memorial Children's Hospital

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dc.contributor.authorSpearman, C W N
dc.contributor.authorMcCulloch, M
dc.contributor.authorMillar, A J W
dc.contributor.authorBurger, H
dc.contributor.authorNumanoglu, A
dc.contributor.authorGoddard, E
dc.contributor.authorGajjar, P
dc.contributor.authorDavies, C
dc.contributor.authorMuller, E
dc.contributor.authorMcCurdie, FJ
dc.contributor.authorKemm, D
dc.contributor.authorCywes, S
dc.contributor.authorRode, H
dc.contributor.authorKahn, D
dc.date.accessioned2017-07-07T09:29:16Z
dc.date.available2017-07-07T09:29:16Z
dc.date.issued2006
dc.date.updated2016-01-12T09:16:13Z
dc.description.abstractThe 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.identifierhttp://dx.doi.org/10.7196/SAMJ.1295
dc.identifier.apacitationSpearman, C. W. N., McCulloch, M., Millar, A. J. W., Burger, H., Numanoglu, A., Goddard, E., ... Kahn, D. (2006). Liver transplantation at Red Cross War Memorial Children's Hospital. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24709en_ZA
dc.identifier.chicagocitationSpearman, C W N, M McCulloch, A J W Millar, H Burger, A Numanoglu, E Goddard, P Gajjar, et al "Liver transplantation at Red Cross War Memorial Children's Hospital." <i>South African Medical Journal</i> (2006) http://hdl.handle.net/11427/24709en_ZA
dc.identifier.citationSpearman, 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.identifier.ris TY - Journal Article AU - Spearman, C W N AU - McCulloch, M AU - Millar, A J W AU - Burger, H AU - Numanoglu, A AU - Goddard, E AU - Gajjar, P AU - Davies, C AU - Muller, E AU - McCurdie, FJ AU - Kemm, D AU - Cywes, S AU - Rode, H AU - Kahn, D AB - 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. DA - 2006 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - Liver transplantation at Red Cross War Memorial Children's Hospital TI - Liver transplantation at Red Cross War Memorial Children's Hospital UR - http://hdl.handle.net/11427/24709 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24709
dc.identifier.vancouvercitationSpearman CWN, McCulloch M, Millar AJW, Burger H, Numanoglu A, Goddard E, et al. Liver transplantation at Red Cross War Memorial Children's Hospital. South African Medical Journal. 2006; http://hdl.handle.net/11427/24709.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Child and Adolescent Psychiatryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceSouth African Medical Journal
dc.source.urihttp://www.samj.org.za/index.php/samj
dc.titleLiver transplantation at Red Cross War Memorial Children's Hospital
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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