Survival and Complication of Liver Transplantation in Infants: A Systematic Review and Meta-Analysis

Abstract

Background: Modern surgical techniques and scientific advancements have made liver transplant (LT) in infants feasible. However, there are only a small number of studies examining the short- as well as long-term outcomes of LT in this vulnerable subset of children. Methods: Comprehensive searches were done systematically through the PubMed, Scopus, and Google scholar databases. Studies that were retrospective record based or adopted a cohort approach and reported either patient survival rates or graft survival rates or complications of LT in infants were included in the meta-analysis. Statistical analysis was done using STATA version 13.0. Results: A total of 22 studies were included in the meta-analysis. The overall pooled patient survival rate at 1 year, >1–5 years, and >5 years post-transplantation was 85% (95% CI: 78-−92%), 71% (95% CI: 59–83%), and 80% (95% CI: 69–91%), respectively. The overall pooled graft survival rate at 1 year, >1–5 years, and >5 years post-transplantation was 72% (95% CI: 68–76%), 62% (95% CI: 46–78%), and 71% (95% CI: 56–86%), respectively. The overall pooled rate for vascular complications, need for re-transplantation, biliary complications, and infection/sepsis was 12% (95% CI: 10–15%), 16% (95% CI: 12–20%), 15% (95% CI: 9–21%), and 50% (95% CI: 38–61%), respectively. Conclusion: The current meta-analysis showed modest patient and graft survival rates for infant liver transplantation. However, the complication rates related to infection/sepsis were high. More comprehensive evidence is required from studies with larger sample sizes and a longer duration of follow-up.