The current status of pediatric liver transplantation in Mainland China

The aim of this article is to study the current status of pediatric liver transplantation in Mainland China. A total of 337 cases of pediatric liver transplantation enrolled in CLTR between 1993 and May 2009 were analyzed retrospectively. The median transplant age was 8.7 yr (64 day-17.8 yr), and Wilson's disease was the most common indication (35.4%). Liver transplantation for biliary atresia accounted for 49.3% and 54.2% in 2008 and 2009 and had become the most common indication nowadays. One- and three-yr survival rates of children transplanted at age < 1 yr were 69.2% and 59.3%, respectively, and were significantly worse than those transplanted at age >= 1 yr (83.9% and 76.6%, p < 0.05).In 63.8% (208/326) of the patients, LDLT was used with an overall one- and three-yr survival rates of 87.5% and 84.4%, respectively. The one- and three-yr survival for DDLT was significantly lower (66.7% and 52.2%, p < 0.05). The one- and three-yr survival rates for those transplanted in era 1993-2000 were 63.6% and 36.4%, respectively, and the one- and two-yr survival rates in the latest era (2007-2009) were markedly improved (81.9% and 79.0%, p < 0.05). Cox's analysis identified DDLT (HR = 2.90, CI 95% 1.5-5.6), being transplanted in era 1993-2000(HR = 3.4, CI 95% 1.1-10.2), fulminant liver failure (HR = 6.0, CI 95% 2.0-17.5), and malignancy (HR = 3.8, CI 95% 1.4-10.3) as predictors of increased mortality, and children transplanted at age 8-17 yr have an better survival (HR = 0.2, CI 95% 0.1-0.6). We concluded that pediatric liver transplantation is gradually developing and would probably be a promising therapy for pediatric end-stage liver diseases in Mainland China.