Liver transplantation for Wilson's disease in pediatric patients: decision making and timing.

Abstract

Transplantation for Wilson's disease occupies 1/3 of the cases for metabolic diseases in Japan. At the end of 2009, 109 transplantations had been performed including three deceased donor cases in the Japanese registry. We herein discuss problems of transplantation for Wilson's disease as well as its indication, timing, and social care. We retrospectively reviewed four fulminant cases and two chronic cases who underwent living donor liver transplantation. There were two boys and two girls. Four adolescents of average age 11.3 years underwent living donor liver transplantation. Duration from onset to transplantation ranged from 10 to 23 days. Average Model for End-stage Liver Disease (MELD) score was 27.8 (range=24-31). All patients were administrated chelates prior to transplantation. MELD, New Wilson's index, Japanese scoring for liver transplantation, and liver atrophy were useful tools for transplantation decision making; however, none of them was an independent decisive tool. Clinical courses after transplantation were almost uneventful. One girl, however, developed an acute rejection episode due to noncompliance at 3 years after transplantation. All patients currently survive without a graft loss. No disease recurrence had been noted even using living related donors. Two adults evaluated for liver transplantation were listed for deceased donor liver transplantation. Both candidates developed cirrhosis despite long-term medical treatment. There were no appropriate living donors for them. There are many problems in transplantation for Wilson's disease. The indications for liver transplantation should be considered individually using some decision-making tools. The safety of the living donor should be paid the most attention.

• Authors: S Narumi, M Umehara, Y Toyoki, K Ishido, D Kudo, N Kimura, T Kobayashi, M Sugai, K Hakamada
• Journal: Transplantation proceedings (Transplant Proc) Vol. 44 Issue 2 Pg. 478-80 (Mar 2012) ISSN: 1873-2623 [Electronic] United States
• PMID: 22410050 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Chelating Agents

Topics

• Acute Disease
• Adolescent
• Chelating Agents (therapeutic use)
• Child
• Decision Support Techniques
• Female
• Graft Rejection (etiology)
• Hemodiafiltration
• Hepatolenticular Degeneration (complications, diagnosis, surgery)
• Humans
• Japan
• Liver Cirrhosis (diagnosis, etiology, surgery)
• Liver Failure, Acute (diagnosis, etiology, surgery)
• Liver Transplantation (adverse effects)
• Living Donors
• Male
• Middle Aged
• Patient Selection
• Plasmapheresis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Waiting Lists
• Young Adult