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One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned.

Abstract：

BACKGROUND:Pediatric liver transplantation (pLTx) has been the standard of care for children with liver failure since the 1980s. This study examined the world's largest single-center experience and aimed to identify unique preoperative predictors of early graft and patient survival for primary transplantation (1°-pLTx) and retransplantation (Re-pLTx). STUDY DESIGN:We conducted an IRB-approved, retrospective study of all consecutive, isolated pLTx patients 18 years of age or younger. Twenty-eight demographic, laboratory, and perioperative variables were analyzed as potential outcome predictors. Univariate and multivariate analyses were performed using log-rank test and Cox's proportional hazards model. RESULTS:There were 806 children who received 1,016 isolated pLTx between February1984 and June 2017. Median follow-up was 12 years. Leading indications for pLTx were cholestatic liver disease (40%), re-pLTx (21%), and fulminant hepatic failure (14%). Seventy-three percent received cadaveric whole grafts. Overall graft and patient survival rates at 0.5, 1, 5, 10, and 20 years were: 76%, 73%, 67%, 63%, 53%, and 87%, 86%, 81%, 78%, 69%, respectively. Relative to 1°-pLTx, re-pLTx recipients were significantly older, larger, with worse renal function, and more likely to be awaiting pLTx in an ICU. Independent significant predictors of graft survival for 1°-pLTx included weight, transplantation era, and renal replacement therapy; for re-pLTx, warm ischemia time and time between 1°-pLTx and re-pLTx. Independent significant predictors of patient survival were renal function, mechanical ventilation, and etiology of liver disease. CONCLUSIONS:This is the largest reported single-center experience of pLTx with substantial follow-up time and a large re-pLTx experience. Important transplant predictors of graft survival include weight, renal function, modern era, warm ischemia time, and time between primary transplantation and re-pLTx. Renal function, mechanical ventilation, and underlying cause of liver disease affect patient survival. Awareness of these factors can help in the decision making for children requiring pLTx.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Venick RS,Farmer DG,Soto JR,Vargas J,Yersiz H,Kaldas FM,Agopian VG,Hiatt JR,McDiarmid SV,Busuttil RW

doi

10.1016/j.jamcollsurg.2017.12.042

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

355-366

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(18)30023-1

journal_volume

226

pub_type

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One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned.