Pediatric liver transplant recipients: mortality analysis over 20 years

Orthotropic liver transplantation (OLT) has become standard and accepted care for pediatric patients with end-stage liver disease. Two large pediatric OLT series are analyzed to determine excess death rates (EDR) over 20 years. The EDR decreases over time and is lower with more recent transplant recipients who have benefited from improved tacrolimus-based immunosuppression and transplant techniques. Fifteen- to 20-year EDR is 5 deaths/1000. Biliary atresia is the most common pediatric indication, and these recipients do better than those with other types of liver disease. Most deaths occur in the first post-transplant year, with infection being the largest cause.