Transplant Without Borders: Clinical Outcomes and Challenges in Transborder Living Donor Pediatric Liver Transplantation in Jordan
Notice bibliographique
Résumé
Purpose: To describe the clinical outcomes, complications, and logistical challenges of pediatric living donor liver transplantation (LT) in Jordanian children referred abroad, in the absence of a national transplant program. Patients and Methods: This retrospective study reviewed all pediatric cases referred to the Jordanian Center for Organ Transplantation (JCOT) for LT between 2019 and 2023. Data were collected from JCOT records and follow-up interviews with caregivers. Variables included patient demographics, indications for transplantation, donor-recipient relationships, post-operative complications, survival outcomes, and financial aspects. Results: A total of 31 children were referred for LT, of whom 20 (64.5%) successfully underwent living donor liver transplantation abroad—primarily in Turkey—while 11 (35.5%) remained on the waiting list. Biliary atresia (25%) was the most common indication, followed by Alagille syndrome and progressive familial intrahepatic cholestasis (each 20%). Primary hyperoxaluria, Crigler-Najjar syndrome, and maple syrup urine disease were also observed. Parents were the most frequent donors (70%). The most common complications were bile duct leakage (35%), portal vein thrombosis (20%), and infections (15%). The 5-year post-transplant survival rate was 90%. Among the waiting list group, four children (36.4%) died before receiving a transplant. No children underwent transplantation for pediatric acute liver failure during the study period. The average cost per transplant covered by the Ministry of Health was $61,071, excluding out-of-pocket expenses borne by families. Conclusion: This study highlights the feasibility and challenges of transborder pediatric liver transplantation in Jordan. While clinical outcomes for transplanted children were favorable, significant barriers remain, including delayed referrals, financial strain, and mortality among waitlisted patients. These findings underscore the urgent need to establish a national pediatric liver transplant program to improve timely access and long-term care for children with end-stage liver disease in Jordan. Plain Language Summary: In Jordan, children who need liver transplants do not have access to a transplant center within the country. Instead, they must travel abroad—usually to Turkey—for this life-saving surgery. This study looked at how this process works, what challenges families face, and how children do after their transplants. The researchers reviewed the records of all Jordanian children referred for liver transplantation between 2019 and 2023. They found that 20 children successfully received a transplant abroad, while 11 others were still waiting. The most common reason for needing a liver transplant was a condition called biliary atresia, which blocks bile flow from the liver and can cause liver failure in infants. All transplants were done using living donors, usually a parent. Although most children who received a transplant survived and did well, many faced serious complications after surgery, such as bile leakage or infections. Sadly, four children on the waiting list died before they could get a transplant. Families also faced financial and emotional stress due to the travel, paperwork, and long hospital stays. This study is the first to describe how pediatric liver transplantation works in Jordan under the current system. It shows that while the overseas model can save lives, it also has major challenges. The researchers highlight the urgent need for a national transplant center in Jordan, along with better coordination, earlier referrals, and long-term follow-up care for these children. Keywords: pediatric hepatology, cross-border healthcare, living donor surgery, organ transplant outcomes, health system barriers, Jordan
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| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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