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Published on: January 2, 2017
Graft survival in pediatric liver transplantation
M R Langham1, A G Tzakis, R Gonzalez-Peralta
1Department of Surgery, University of Florida, Gainesville, FL 32610-0286, USA.
Insights
Pediatric liver transplantation outcomes are excellent, but split grafts show increased graft loss. Improving split graft survival could significantly reduce pediatric liver transplant morbidity and costs.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Background:
- Liver transplantation is a critical treatment for pediatric liver diseases.
- Organ donor shortages necessitate innovative graft utilization strategies.
- Reduced, split, and living-donor grafts are increasingly employed in pediatric liver transplantation.
Purpose of the Study:
- To evaluate the impact of reduced, split, and living-donor grafts on graft survival in pediatric liver transplantation.
- To analyze outcomes in children undergoing liver transplantation within a statewide program.
Main Methods:
- Retrospective analysis of pediatric liver transplant recipients (<21 years) from January 1, 1996.
- Utilized nonparametric tests of association and life table analysis.
- Data encompassed 123 children receiving 147 grafts across two high-volume centers.
Main Results:
- Overall patient survival rates were high and comparable between centers (1-year actuarial survival: 88.4% and 87.1%).
- Graft types included whole (60%), reduced (17%), and split (19%).
- One-year graft survival rates were 80% for whole, 71.6% for reduced, and 64.3% for split grafts (P=.06).
Conclusions:
- Pediatric liver transplant survival is excellent regardless of graft type.
- Split grafts are associated with higher graft loss and retransplantation rates.
- Enhancing split graft survival could significantly decrease pediatric liver transplant morbidity and healthcare costs.
Background/Purpose:
Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation.
Methods:
Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12).
Results:
One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36%) children were less than 1 year of age at time of transplant, and 80 (55%) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) grafts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P =.06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P <.01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival.
Conclusions:
The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.
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