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��ࡱ�>��	�����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������[�	��0�sbjbj����	�&ΐΐ�iO-����������'''4����[[[h�\t[:4��Z�* ��!��"d�3�3�3�3�3�3�3�5��8>�3-'&#& * &#&#�3''#�3`.`.`.&#�''�3`.&#�3`.`.C0�0�����M/[�[�+*[0�3
40:4c0,�8-`�8�0�0��8'51|&#&#`.&#&#&#&#&#�3�3`.&#&#&#:4&#&#&#&#���������������������������������������������������������������������8&#&#&#&#&#&#&#&#&#�	�:	Scientific publications regarding pediatric liver transplantation: a 20-year analysis 

Marjan Joudi1, Mehdi Fathi2*, Maryam Joudi3, Gholamreza Habibi4, Mahdi Hosseinian-Sarajehlou4, Roghayeh Ghazavi4, 
Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Anesthesia, Mashhad University of Medical Sciences, Mashhad, Iran
Department of Pediatrics, Zahedan University of Medical Sciences, Zahedan, Iran
Farzan Clinical Research Institute, Tehran, Iran

Running title: pediatric liver transplantation

Corresponding Author: Mehdi Fathi
 P.O.Box:13586-1678, Tehran, Iran
Tel: +9821 66423101
Fax: +9821 66423304
Email: swt_f@farasa.org




Abstract
Background: Liver transplantation is the main treatment option in end stage liver disease. Identification of the most influential published scientific research through scientometric analysis would help the authorities and researchers in this field, to find and benefit from the most informative, and important scientific material and also learn about the new research trends and dynamic changes in this specific field. The aim of the study was to analyze the scientometric parameters in the field of pediatric liver transplantation.
Methods: A scientometric analysis was performed on the scientific research papers about pediatric liver transplantation published between 1993 and 2012. The data were retrieved from Thomson Reuters Web of Science. Number of published documents, year, language, the most productive and influential journals, authors and affiliations of the contributing authors, subject trends and international scientific collaborations were analyzed; using Histcite, CiteSpace and Pajek softwares.
Results: 9364 documents were published, as retrieved by the search terms �pediatric liver transplantation� and the derivatives and synonyms of this term in the topic. Citation analysis showed that 9364 items had 143207 global citations and 32713 local citations since1993. The maximum citation per year was in 2000. Published items originated from 78 countries.
Conclusion: The present study provides the first comprehensive scientometric analysis of the content and impact of published research in the field of pediatric liver transplantation. Results were indicative of an increase in the number of pediatric liver transplantation articles since 1993, and according to the citation analysis, there was an increasing interest in this topic. Also there is an extensive international scientific collaboration in this field. 
Keywords: transplantation, Liver, bibliometric, pediatric

Introduction
The first liver transplantation was performed by T.E. Starzl in 1967[HYPERLINK \l "_ENREF_1"1]. At this point, liver transplantation is the most important therapeutic strategy for end stage liver disease [HYPERLINK \l "_ENREF_2"2]. In 1983, The National Institutes of Health Consensus Conference announced the liver transplantation as the standard of care for patients with life-threatening liver disease [3]. The main indications of liver transplantation in the pediatric population include biliary atresia, sclerosing cholangitis, Alagille�s syndrome, progressive familial intrahepatic cholestasis, Wilson�s disease, Crigler-Najjar syndrome, acute liver failure, primary liver tumors and cystic fibrosis [4-6]. Numerous studies have evaluated the predictors of survival and outcome, co-morbidities, post-transplant complications and the donors� health situation after transplantation [2,4,7-14]. 
Scientometrics is the method for measuring and analysing science research. It represents quantitative features and characteristics of science and scientific research [15,16]. This method is used in investigations in which the development and mechanism of science are studied by statistical mathematical methods. Scientometrics is usually performed using  HYPERLINK "http://en.wikipedia.org/wiki/Bibliometrics" \o "Bibliometrics" bibliometrics which is a measurement of the impact of scientific publications. Most of the works that fall under this category involve various types of citation analysis.�This data can show the networks of scholars and scholarly communication, links between researchers, and the development of areas of knowledge over time [15,16].
Scientometric assessment of organ transplantation especially liver transplantation literature rarely has been performed and virtually it is unexplored in general, and specifically for pediatric liver transplantation [17-19]. 
Obviously, previous research data can be re-used; however, it is necessary to analyze the existing data and determine the best roadmap in the design of new research studies. 
A large number of scientometric studies in various medical subjects and fields have shown the value of scientometric indicators and tools in the evaluation of research and scientific output.
Scientometric assessment is new to organ transplantation especially in pediatric liver transplantation. To our knowledge there is no comprehensive information about research and science about pediatric liver transplantation in the world. 
However, there is few local scientometric data about liver transplantation in some countries. Lai et al in 2012 analyzed the top-100 most highly cited articles published in this field extracted from the Scopus database [20]. In another publication by Bas et al in 2011, the authors analyzed scientific works published and indexed in SCI-E in Turkey from 1980 to 2011 [18]. Our colleagues from Iran applied bibliometric analysis to the Iranian pediatrics articles published in PubMed indexed journals between 1975 and 2007 [21].
By scientometric analysis, current status of research and scientific knowledge about pediatric liver transplantation and its trend during the time will be depicted and gap in knowledge will be determined.
The main goal of the current study was to illustrate current status of science and scientific research and publication trend during the time in the field of pediatric liver transplantation in the world by descriptive analysis of retrieved data. The present scientometric analysis intended to assess the following parameters including total number of published documents and citations, numbers of published items by each country, the distribution of number of publications during a specific period of time, publishing journals and languages, the most influential journals, authors and institutions, distribution of subjects in this field and their changes during a specific period of time, and international scientific collaboration networks in this topic. 

Materials and Methods
Data Source
Data were collected from the Web of Science developed by the Thomson Reuters Institute for Scientific Information [22,23].
Search Strategies
We performed a search in the Thomson Reuters Web of Science database portal using the terms �liver transplant OR liver graft*� and �pediatric* OR paediatric* OR child*� in the subcategory of �Topic� to retrieve all derivatives of these words. Because the present study was designed to assess the total number of publications in the field of pediatric liver transplant, we did not use the �refine� feature of the Web of Science database to include only document types such as original articles, reviews, and abstracts or to exclude others such as letters, editorials, and news reports. The publication time was chosen to be between years 1993 to 2012.
Evaluations
Number of items and citations per year, rate of growth in the number of publications, producing countries and institutions, publishing journals and their fields and impact factors, the most productive and influential journals, and the contributing authors were analyzed. Collaboration networks between different countries, distribution of these networks according to the research topics and the trends in changes in the topics during this period of time were analyzed. All the retrieved data were examined for a number of variables including country of origin, publication language, publication year, subject category, authors and citation frequency. Professional softwares for scientometric analysis namely HistCite, CiteSpace and Pajek were used for the data analysis and visualization.

Results
Total Number of Published Items
The number of published items was used as an index of research productivity. During the period of 1993 to 2012, 9361 items were published and indexed in the Thomson Reuters Web of Science when the search terms �pediatric� and �liver transplant� (and any of their derivatives and synonyms) were used to search in the topic. The published documents included 5621 articles (60.03%), 1382 meeting abstracts (14.76%), 1299 proceeding articles (13.87%), 678 reviews (7.24%), 217 editorial materials (2.32%), 90 Letters (0.96%), 54 notes (0.58%) and 15 corrections (0.16%), 4 Book chapters (0.04%), 2 Reprints (0.02%) and 1 for each one of the Discussion and News Item (0.01% for each one) . 
There was a considerable peak in 2005, 2007 and 2011 in the number of publications (Figure 1). The maximum number of items was in the year 2011 with 765 publications (8.20%). The growth rate of documents in WoS database from 1993 to 2012 was 6.92%, which is an important indicator of scientific development in each scientific field.


Total Number of Citations
Total citation number for all documents was 143207 times since 1993 by other documents in the Web of Science database (TGCS), Total number of citations excluding the self citations was 109326 times, and was 32713 times since 1993 when analyzed based only on the documents in retrieved set (9361 documents) (TLCS) (Figure 2). From all the published articles, 55 had the highest TLCS (more than 50 citations) and 50 had the highest TGCS (more than 200 citations). The average number of citations per item was 15.28 and general h-index was 129. As seen in following chart (Figure 2) the peak number of global citations was in 2000 with 11476 citations and for local citations was in 2001 with 2326 citations. The average global citation per year was 6819.38 cites.
The most cited articles in the local citation category have been shown in Table 1.
Country of Origin
The published items originated from 78 countries. The most was published articles were from United States (2986 items, 31.9%), England (840 items, 9%), Japan (697 items, 7.4%), Germany (690 items, 7.4%), Italy (590 items, 6.3%) and France (570 items, 6.1%). 
Language
From 9361 published items, 9013 were in English (96.25%), 140 in French (1.5%), 111 in German (1.2%), 66 in Spanish (0.7%), 9 in Italian (0.1%) , 6 in Portuguese (0.06%), 5 in Polish (0.05%), 4 in Russian (0.04), 2 in each of Japanese, Turkish and Greek (0.02% in each one) and 1 in each of Korean, Rumanian and Slovene (0.01% in each one.
Publishing Journals, institutions and authors
In the investigated period of time, among 1015 journal which published 9376 articles, some journals had more productivity than others and some of them were more influential in the field. According to our findings, the most productive journals were �Pediatric transplantation� (IF: 1.548) with 929 articles (9.9%), �Transplantation proceedings� (IF= 1.064) with 695 article (7.4%), �Liver transplantation� (IF= 3.702) with 662 article (7.1%), �Transplantation� (IF= 3.689) with 484 article (5.2%) and �American journal of Transplantation� (IF= 6.025) with 355 article (3.8%). The most influential journals according to the global and local citation analysis were as follow (Table 2). 
Among 3956 institutions active in this field between 1993-2012, �University of Pittsburgh� with 308 articles (3.3%), �Children�s Hospital� with 232 articles (2.5%), �University of California at Los Angeles� with 215 articles (2.3%), �Kings College London Hospital� with 186 articles (2%) and �Kyoto University� with 156 articles (1.7%) were most productive institutions. The most locally and globally influential institutions  are summarized in Table 3, which also shows that most productive institutions were also(to a large extent) the most influential ones). 
About 27377 authors had contributed to the publications in this field. The article titled �Studies of Pediatric Liver Transplantation (SPLIT): Year 2000 outcomes� had the highest number of contributors (98). The most productive authors who had more than 100 articles are as summarized in Table 4.

Subject trends 
The inter-relation of subject categories in the field of pediatric liver transplantation, according to �co-occurring subject category indicator� and �page rank� can be seen in Figure 3. 
The length of lines and their labels indicates the relationship of the (two) subjects and also the strength of the link. The size of nodes shows the frequency of certain subjects and the colors of lines refer to the years which two related subjects frequently appear in articles (as indicated by the colors at the top of the picture). 
There are citation bursts for more important and hot subject categories in different years (implying that which subjects were more popular at a specific point of time). The Strength indicates on the importance and influence of that special subject rater than the others. Figure 4 shows these subjects and specific years for each one:
Collaboration
Among 78 active countries in the field of pediatric liver transplantation research, most countries had scientific collaboration with other countries and contributed to the formation of international collaboration networks (Figure 5). United States has the most collaboration networks with 38 countries and between 8030 authors, following countries had the highest (>=20) number of international scientific collaborations after the United States: UK (with 37 countries), Italy (with 33 countries), Canada (with 32 countries), Germany (with 30 countries),India (with 29 countries), Poland (with 26 countries), Belgium (with 24 countries), Australia (with 24 countries), Japan (with 21 countries), Turkey (with 20 countries). 
 
Discussion
In recent years, publication of numerous studies evaluating outcomes and complications of pediatric liver transplantation has created new challenges in the field of pediatric liver transplantation research.  Present study provides the first large-scale scientometric analysis of pediatric liver transplantation literature. The 6.92% growth rate of scientometric production, which is an important indicator for science development (from 198 items in 1993 to 765 items in 2011 and 662 items in 2012), shows that the interest in pediatric liver transplantation research grew progressively over the time period analyzed. 
Citation indicators in scientometric analysis determine different aspects of influence. Two important citation indicators analyzed in this study were TGCS (Total of Global Citation Score) and TLCS (Total of Local Citation Score). TLCS is more accurate, because it determines the influence of a special document just in the related field and not in all disciplines of science. Therefore the articles with highest the TLCS are the �hot� papers and subjects. The decrease in the number of citations in last years of the study period is due to a delay in recognition and citing of an article (Citation window); nevertheless, both the global and local citations were on the rise. 
United States produced about one third of documents in this topic and about 96% of the total retrieved documents are English language. These findings are similar to the studies addressing other fields of research [24-27]. In the collaboration network, USA and major European countries also had more international scientific collaboration as compared to other countries. This results and the result of other similar researches can be due to the high fund of research in this countries. Comparison of tree indicators (number of publications, local citation and global citation) proved that most productive and influential journals, institutions and authors have the highest score in all of these indicators. Among 1015 journals, �Transplantation�, �Pediatric Transplantation� and �Liver Transplantation�; among 3956 institutions, the �University of California, Los Angeles�, �University of Pittsburgh� and �Children Hospital�; among the 27377 involve authors, �MC Diarmid SV�, �Ottey B�, �Tanaka K�, �Reyes J�, �Reding R�, �oemoto S� and �Mieli-Vergani G� were the most productive and influential items (both locally and globally). These findings indicate the importance of scientific production of the above mentioned resources.
In addition to citation analyses which determine the �hot� publications, there are some indicators that are suitable for identification of hot subjects, emerging trends and the related subjects, like co-occurring words. Some ISI subject categories like �Transplantation�, �Immunology�, �Transplantation Biophysics�, �surgery� and �Gastroenterology and Hepatology� had more frequency in articles. Some of these categories are more related to each other according to the strength of links between them such as: �Transplantation Biophysics�, �Biophysics�, �Oncology�, �Hematology� in one cluster; �Transplantation�, �Infectious disease�, �surgery�, �Microbiology� in the second cluster; and �Pediatric Gastroenterology and Hepatology, �Nutrition and Dietetics�, �Gastroenterology and Hepatology� in another cluster and finally �Cardiac and Cardiovascular Systems� and �Respiratory Systems� in a separate cluster. The subject trends also showed that in the start of studied period of time, the subjects categories related to �Surgery� was more popular and in the last years of this period, this trend changed to the subject categories related to �Transplantation�.
In conclusion, the present study provides the first detailed scientometric analysis of the role and impact of pediatric liver transplantation related research in the field of biomedicine. The results showed an increase in the number of pediatric liver transplantation-focused publications since 1993 and on the basis of the citation analysis results, interest in the results of these studies is also on the rise. 

Acknowledgement
The authors wish to thank Farzan Institute for Research and Technology for technical assistance.
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Table 1: The most cited articles by the 9361 documents in the studied field. (TLCS)

TitleAuthor JournalYearTopicTLCSTGCS1Surgical techniques and innovations in living related liver-transplantationTanaka K, et al.Annals of Surgery1993 Jannovel surgical technique in living related liver-transplantation1853832Long-term results of pediatric liver transplantation - an analysis of 569 transplantsGoss JA, et al.Annals of Surgery1998 SepLong-term outcome of liver transplantation in children 125151
Table 2: The most influential global and local journals, in the field of pediatric liver transplantation from 1993 to 2012
JournalIFRecsTLCSJournalIFRecsTGCS1Transplantation 3.6894844950Transplantation3.689484146452Pediatric Transplantation1.5489292535Hepatology11.089346123283Annals of Surgery8.875942310Liver Transplantation3.70266280424Liver Transplantation3.7026622183Annals of Surgery8.8759477385Journal of Pediatric Surgery1.5582872106Pediatric Transplantation1.5489295470

Table 3: The most globally and locally influential institutions, in the field of pediatric liver transplantation from 1993 to 2012
InstitutionRecsTLCSInstitutionRecsTGCS1Univ Calif Los Angeles2152239Univ Pittsburgh30876912Univ Pittsburgh3082106Univ Calif Los Angeles21556973Childrens Hosp2321413Univ Calif San Francisco13648254Kyoto Univ1561308Childrens Hosp2324527Table 4: The most productive authors, in the field of pediatric liver transplantation from 1993 to 2012 and their influence in the field
AuthorRecsPercentTLCSTGCS1Dhawan A1531.666315432Rela M1411.580518973Tanaka K1321.4143836824Mieli-Vergani G1311.479924445Burdelski M1191.383215476Uemoto S1171.2101326837Reding R1141.2125021058Kelly DA1131.276719829McDiarmid SV1121.21531317610Reyes J1111.21333366411Ganschow R1081.236660212Otte JB1081.21454266113Chen CL1051.121651314Haberal M1031.114333815Colledan M1001.1259478

Figure legends:
Figure 1. The number of published articles in the field of pediatric liver transplantation from 1993 to 2012
Figure 2. The number of citation for the pediatric liver transplantation publications from 1993 to 2012. 
Figure 3. Distribution of the inter-relation of subject categories in the field of pediatric liver transplantation from 1993 to 2012
Figure 4. Subject trends in different years, in the field of pediatric liver transplantation from 1993 to 2012 according to burst terms
Figure 5. Collaboration network between different countries, in the field of pediatric liver transplantation from 1993 to 2012

. Total of Global Citation Score (TGCS): The number of citations which each document received from other documents in the web of science database.
. Total of Local Citation Score (TLCS): The number of citations which documents received from other documents just in the investigated set. 
  The five year Impact Factor of journals











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