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Analysis of risk factors following pediatric liver transplantation
C Margarit1, M Asensio, R Dávila
1Unidad de Trasplante Hepático, Hospital General Vall Hebrón, Barcelona, Spain.
Insights
Pediatric liver transplantation (LT) survival is impacted by patient condition and complications. Primary non-function (PNF) and hepatic artery thrombosis (HAT) significantly decrease survival rates in children undergoing LT.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Liver transplantation (LT) is a critical treatment for end-stage liver disease in children.
- Understanding factors affecting survival is crucial for improving outcomes in pediatric LT.
Purpose of the Study:
- To identify recipient, donor, operative, and postoperative factors influencing patient survival after pediatric LT.
- To analyze the impact of specific complications on survival rates in children undergoing LT.
Main Methods:
- Univariate and multivariate analyses were performed on data from 103 pediatric patients undergoing 120 LTs over 13 years.
- Patient survival rates were assessed using actuarial methods at 1, 5, and 10 years post-transplantation.
Main Results:
- Overall actuarial survival rates at 1, 5, and 10 years were 70%, 61%, and 57%, respectively.
- Independent factors associated with decreased survival included United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thrombosis (HAT) (RR = 3.8).
Conclusions:
- Postoperative mortality in pediatric LT is primarily driven by the patient's pre-transplant condition and complications like PNF and HAT.
- Addressing pre-transplant status and mitigating risks of PNF and HAT are essential for enhancing survival in pediatric liver transplantation.
Abstract:
Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses. In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36% were under 2 years of age. Indications for LT were cholestatic disease in 68 (56%), metabolic diseases in 18 (14%), fulminant hepatic failure in 8 (7.5%), cirrhosis in 7 (5.8%), and retransplants in 17 (14%). Whole liver was transplanted in 79% of cases and partial liver in 21%. Actuarial survival at 1, 5, and 10 years was 70%, 61%, and 57%, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thrombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.