The need for liver transplant in a sample of Iraqi children with chronic liver disease

Abstract

Liver disease is one of the major causes of hospitalization and mortality in children. A wide spectrum of disorders including developmental abnormalities, infections, metabolic and genetic disorders can lead to liver disease in pediatric patients. Determination of its etiology is important for treatment, prevention of progressive liver damage, family counseling and prioritizing liver transplantation. We aimed to assess the need of Iraqi children with chronic liver disease and acute liver failure for liver transplantation and to discover the commonest indication for liver transplant in Iraqi children. Patients and methods: A retrospective study of patients’ files and records from early neonatal period up to 14 years of age with end stage liver disease and patients with acute liver failure that carried out in welfare teaching hospital and the gastroenterology center of the medical city, during a period from 1^st of August 2019 to 30^th of April 2021. A pre-constructed data collection sheet, consisted of two sections: the first section gathering the socio-demographic data (age, sex, residence (province). The second section included the clinical data; etiology and lab investigations results. Mean pediatric end stage liver diseases (PELD) score was calculated to all cases depending on their age, gender, growth parameter (height and weight) and laboratory investigations results (Total serum bilirubin level, albumin, international normalized ratio {INR}). Statistical analysis was performed using SPSS software version 23. Result: A total number of 369 patients were enrolled, the mean ± sd age was 4.8±4 years, ranging between 2 month and 14 years, 39% of patients were between age 3-10 years. 212 male patients and 157 female patients. 27.4% of patients had progressive familial intrahepatic cholestasis (PFIC), 15.8% had chronic liver disease, 12.5% had Wilson disease, 9.2% had glycogen storage disease, 7.9% had autoimmune hepatitis, 6% had drug induced, 4.5% had biliary atresia. 73.7% had PELD score less than 11 and PELD score significantly associated with present of complication like ascites and encephalitis and had positive correlation with liver enzyme and PT with negative correlation with age and vit D. Conclusion: there was a high percentage of Iraqi children who were complaining of end stage liver disease and acute liver failure and in need for liver transplantation and a significant proportion of studied children were need to frequent evaluation and follow up according to pediatric end stage liver disease score and there were a problem in our country because of the lack of some specific tests needed to determine the etiological diagnosis and lack of a program of hepatic transplantation.