Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2024 Apr 24;114(3b):e1190. doi: 10.7196/SAMJ.2024.v114i3b.1190.
The Wits Transplant Unit performed its first paediatric liver transplant in 2005. Initial experiences from the unit were published in 2012 and 2014. Since then, significant progress has been made in capacity-building the unit, improving outcomes and enhancing service delivery. This paper presents a broad overview and update of the unit's 17-year experience. Methods: We conducted a retrospective review of all paediatric liver transplants performed in Johannesburg from 1 January 2005 to 31 December 2021 with a minimum one-year follow-up. Data were accessed from the Wits Donald Gordon Medical Centre Paediatric Liver Transplant Research Database (University of the Witwatersrand Human Research Ethics approval: M190749). The following data were collected: donor and recipient sociodemographic and clinical characteristics, details of transplant procedures, donor grafts and recipient outcomes (post-operative complications, graft and recipient survival). Results: A total of 270 transplants were performed during the review period. Two thirds of recipients (n=180, 67%) were younger than 5 years at time of transplant and half (n=135, 50%) received a living donor graft. The most common indication for liver transplant was biliary atresia, followed by acute liver failure. Unadjusted recipient survival was 80% (95% CI: 75-85%) at one year, and 68% (95% CI: 59-75%) at five years. Waiting list mortality decreased from 27.3% in 2017 to 5.9% in 2021. One hundred and fifty-four (57.0%) recipients experienced at least one type of intervention requiring surgical complication - the most common being biliary in nature (n = 91; 33.7%). Conclusion: Over last seventeen years, a sustainable paediatric liver transplantation service has been established in Johannesburg. Living donor, split and ABO incompatible liver transplants have been incorporated in response to the severe organ shortage in South Africa. However, our outcomes can be improved. Additionally, a national transplant initiative to coordinate timeous referrals and expand access to liver transplantation for children with severe acute and chronic liver failure is advised.
威特沃特斯兰德大学移植科于 2005 年完成了首例儿科肝移植手术。该科室于 2012 年和 2014 年发表了最初的经验。自那时以来，该科室在能力建设、改善结果和提高服务交付方面取得了重大进展。本文介绍了该科室 17 年经验的广泛概述和更新。
我们对 2005 年 1 月 1 日至 2021 年 12 月 31 日期间在约翰内斯堡进行的所有儿科肝移植进行了回顾性审查，随访时间至少为 1 年。数据来自威特沃特斯兰德大学唐纳德·戈登医学中心儿科肝移植研究数据库（威特沃特斯兰德大学人类研究伦理委员会批准：M190749）。收集了以下数据：供体和受体的社会人口学和临床特征、移植程序细节、供体移植物和受体结果（术后并发症、移植物和受体存活率）。
在审查期间共进行了 270 例移植。三分之二的受者（n=180，67%）在移植时年龄小于 5 岁，一半（n=135，50%）接受了活体供体移植。肝移植的主要适应证是胆道闭锁，其次是急性肝衰竭。未调整的受体 1 年存活率为 80%（95%CI：75-85%），5 年存活率为 68%（95%CI：59-75%）。等待名单死亡率从 2017 年的 27.3%下降到 2021 年的 5.9%。154 名（57.0%）受者经历了至少一种需要手术干预的并发症-最常见的是胆道相关并发症（n=91；33.7%）。
在过去的 17 年中，约翰内斯堡已经建立了一个可持续的儿科肝移植服务。活体供体、劈裂和 ABO 不相容肝移植已被纳入其中，以应对南非严重的器官短缺。然而，我们的结果可以得到改善。此外，建议采取国家移植倡议，以协调及时转诊，并扩大严重急性和慢性肝功能衰竭儿童的肝移植机会。
