European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

BACKGROUND & AIMS: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.APPROACH & RESULTS: Over a 50 years period (1968 - 2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to 3 successive periods (A: before 2000, B: 2000 to 2009, and C: since 2010), studying donor and graft characteristics, and graft outcome. The use of living donors steadily increased from A to C [A: n=296 (7%), B: n=1131 (23%) and C: n=1985 (39%); P=0.0001]. Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (pCONCLUSIONS: Pediatric liver transplantation has reached a high efficacy as a cure, or treatment, for severe liver disease in infants and children. Grafts that survived the first year had a half-life time similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to re-visit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.