[Pediatric liver transplantation--experience at Schneider Children's Medical Center].

BACKGROUND: Introduction of segmental graft transplantation from living donors and split livers from cadaver donors has led to major advances in liver transplantation (LTx) in children. AIM: To report our initial experience with pediatric LTx performed at our center. METHODS: Data collection on all children undergoing LTx between the years 1996-2003 including the analysis of the graft and patient survivals and reports of complications. RESULTS: Forty LTx were performed in 38 children at the mean age of 6.2 years, including two retransplants. There were 15 whole liver allografts and 25 segmental grafts including: 12 living donor grafts, 5 splits and 8 reduced grafts from cadaver donors. At 40 months mean follow-up period, patient and graft survival were 81% and 72.5%, respectively. There was post-transplant mortality in seven cases--5 children died during the first month and two children passed away after 6 months (recurrent disease) and 14 months (metastatic tumor). Vascular complications included: one early and one late portal vein thrombosis (5%) and six cases of hepatic artery thrombosis (15%). In the latest group, 3 grafts were salvaged by thrombectomy and another 3 children underwent re-transplantation. There were two bile leaks (5%) and 6 bile duct strictures (15%). The bile-duct strictures were successfully corrected by surgery in one child and by transhepatic dilatation in another 4 children. One child remained with intrahepatic strictures in one of the two hepatic segments. CONCLUSIONS: The use of segmental liver allografts enables the performance of pediatric liver transplantation in Israel. Gathered experience and enhanced skills will ensure improved results over time.

BK virus infection and its effect on renal function in pediatric liver-transplant recipients: a cross-sectional, longitudinal, prospective study.

BACKGROUND: Chronic renal failure (CRF) is a well-documented complication of liver transplantation. BK virus (BKV) is a common cause of CRF in renal-transplant recipients and has been sporadically associated with renal failure after nonrenal solid-organ transplantation. The aims of the study were to determine the prevalence of BK viruria and viremia in pediatric liver-transplant recipients, assess the natural course of BKV infection over time, and examine the association between BKV positivity and renal function. METHODS: A prospective, cross-sectional study of 59 pediatric liver-transplant recipients. Blood and urine samples were collected at enrollment for creatinine level and BKV polymerase chain reaction test. BKV-positive patients underwent repeated testing and follow-up. The medical files were reviewed for clinical data. RESULTS: Median age at enrollment was 11.5 years, and median time from transplantation was 61 months. One child (1.7%) had viremia, and nine children (15.3%) had viruria (median: 610 copies/mL). All cases of viruria/viremia resolved spontaneously, nine of them within 10 months. There were no significant differences in demographic or clinical variables between the BKV-positive and BKV-negative children. None of the BKV-positive patients had evidence of renal dysfunction. CONCLUSIONS: Pediatric liver-transplant recipients have a low prevalence of BK viruria/viremia. BKV infection is associated with low viral loads and resolves spontaneously within a relatively short period, without residua. BKV is not associated with CRF postliver transplantation. BKV testing should not be part of the routine follow-up of children after liver transplantation.