Pediatric liver retransplantation: outcomes and a prognostic scoring tool

Nine to twenty-nine percent of pediatric liver transplant recipients require retransplantation. No previous pediatric study has proposed a prognostic scoring system. We have used the United Network for Organ Sharing transplantation database to conduct a retrospective cohort study of patients who were less than 18 years of age when they received their retransplant (n = 1130). Using a random two-thirds of the subjects, we developed a prognostic scoring system by performing a multivariate Cox analysis with non-laboratory clinical characteristics. The scoring system was verified in the remaining one-third of the subjects. Stratifying the verification group into risk groups by prognostic score demonstrated its predictive value. Those in the low-risk category had survival similar to that of primary liver transplant recipients. Those in the high-risk category had 2.4 (95% confidence interval: 1.6-3.7) times the risk of death or retransplantation as those in the low-risk category. Risk factors in the scoring system included being on life support at the time of retransplant, receiving a split liver graft, and having an original diagnosis of neonatal cholestasis, familial cholestasis, paucity of bile ducts, or congenital abnormalities. Protective factors in the scoring system included older age at the time of transplantation and having acute rejection contribute to graft failure. In conclusion, with simple clinical characteristics, this scoring tool can modestly discriminate between those children at high risk and those children at low risk of poor outcome after liver retransplantation.