Liver transplantation in the child. The situation in Europe and personal results of the first 100 patients

: Pediatric liver transplantation in Europe has expanded rapidly during the last four years. The survival rate of the 254 children less than 15 years recorded in the European Registry on December 31, 1987 was 68% at one year and 61% at three years; nineteen centers have contributed to this activity, of which 11 had performed less than 5 cases each while two thirds of the experience was concentrated in three centers (Brussels, Cambridge, Hannover). The results obtained in the first 100 children (65% were younger than 3 years) who received a liver graft at the University of Louvain Medical Center in Brussels between March 1, 1984 and July 31, 1988 are reported. The survival rates (79% at one year and 73% at three year) which do not differ with regard to the age, the indication of the technical modalities (whole liver or reduced size livers) are strongly influenced by the clinical condition (84% vs 50% at one year in elective and emergency transplantations respectively). One third of the 122 grafts transplanted by the authors were reduced livers harvested from older and often adult donors. This technique provides results of equal quality and does not entail an increased rate of technical complications; on the contrary, the incidence of arterial thrombosis has been significantly reduced. Transplantation of a reduced size liver is safe and should be recommended even in elective conditions, in view of the dire shortage of small pediatric donors.