The first report of pediatric liver transplantation in Thailand from the Thai Liver Transplant Registry
Goragoch Gesprasert1, Voranush Chongsrisawat2, Niramol Tantemsapya3, Chollasak Thirapattaraphan1, Bunthoon Nonthasoot4, Chutwichai Tovikkai3, Ake Pugkhem5, Somchai Limsrichamrern3, Adisorn Lumpaopong6, Thanom Supaporn7, Surazee Prommool8, Suporn Treepongkaruna9.
1Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 3Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 4Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; 5Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 6Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand; 7Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand; 8Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 9Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
The subcommittee for Thai Liver Transplant Registry, Thai Transplant Society.
Background: Pediatric liver transplantation (LT) in Thailand started in 1990 using a graft from a deceased donor, followed by living donor liver transplantation (LDLT) in 2001. Pediatric liver transplantation could be reimbursed from Thailand’s Universal Coverage Scheme in 2012. However, the national liver transplant database had not been developed until 2018 by the Thai Liver Transplant Registry with the support from the Thai Transplantation Society.
Methods: The pediatric liver transplant recipients aged under 18 years from 2016 – 2018 were reported from all 4 pediatric liver transplant centers in Thailand. The information on the characteristics of recipients, donors, and transplantation was submitted into the database. The data was annually analyzed and published by the Thai Transplantation Society.
Results: Among 97 pediatric liver transplantations were performed, 77.3% were LDLT. The major leading causes of LT included biliary atresia (74%), acute liver failure (7%), and Alagille’s syndrome (5%). The median waiting time was 154 days (IQR 44-300). The median age of the patients at LT was 568 days (IQR 399-1264), and 60% were below 2 years. The average PELD/MELD score was 21 at the time of transplantation, and 77% had growth delay. For the outcomes, 90-day and 1-year graft and patient survival were 93.7% and 90.5%, respectively. There was no graft loss after one year. The most common cause of graft loss was vascular thrombosis (22.2%), but unknown etiologies were found in 55.5%. None of the patients received re-transplantation. For induction therapy, 40.2% received sole methylprednisolone, and 42.3% received methylprednisolone plus tacrolimus. A combination of tacrolimus plus mycophenolate plus prednisolone (58.8%) was the primary immunosuppressive regimen for maintenance. For the financial aspect, the patients obtained reimbursement mostly from Thailand’s Universal Coverage Scheme (91%) and Civil Servant Beneficiary Scheme (7%).
Conclusion: This report represents the first national report of pediatric liver transplantation in Thailand. The outcomes are comparable to the latest releases from the OPTN/SRTR and ELTR databases.
The authors would like to thank the physicians, nurses, and transplant coordinators from all pediatric liver transplant centers in Thailand for providing the information to the Thai Liver Transplant Registry..
[1] Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int. 2018; 31:1293-1317.
[2] Kwong A, Kim WR, Lake JR, et al. OPTN/SRTR 2018 Annual Data Report: Liver. Am J Transplant. 2020; 20 (Suppl s1) :193-299.
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