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Published on: November 7, 2020
A multivariate analysis of pre-, peri-, and post-transplant factors affecting outcome after pediatric liver
Sue V McDiarmid1, Ravinder Anand, Karen Martz
1Department of Pediatrics and Surgery, University of California, Los Angeles, CA, USA. smcdiarmid@mednet.ucla.edu
Insights
Post-transplant surgical complications significantly increase the risk of patient and graft loss after pediatric liver transplantation. Reoperation and specific complications like vascular thrombosis are key predictors of adverse outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Gastroenterology
Background:
- The Studies of Pediatric Liver Transplantation (SPLIT) database contains over 4000 pediatric liver transplant cases.
- Previous analyses have explored specific outcome factors.
- This study provides a comprehensive analysis of pre-, peri-, and post-transplant factors.
Purpose of the Study:
- To identify independent predictors of 6-month patient and graft survival.
- To analyze factors influencing outcomes in pediatric liver transplantation.
Main Methods:
- Multivariate analysis of 42 pre-, peri-, and post-transplant variables.
- Included 2982 pediatric recipients of a first liver transplant from the SPLIT database.
Main Results:
- Post-transplant complications were the strongest predictors of death or graft loss.
- Reoperation increased risk by 11-fold; specific complications by 4-fold.
- Vascular thrombosis, bowel perforation, septicemia, and retransplantation independently increased risk 3-4 fold.
Conclusions:
- Post-transplant surgical complications are the most significant predictors of 6-month patient and graft loss.
- Recipient ICU intubation at transplant was a significant baseline factor.
- A significant center effect was noted but did not alter the impact of key factors.
Objective:
The purpose of this study was to identify significant, independent factors that predicted 6 month patient and graft survival after pediatric liver transplantation.
Summary Background Data:
The Studies of Pediatric Liver Transplantation (SPLIT) is a multicenter database established in 1995, of currently more than 4000 US and Canadian children undergoing liver transplantation. Previous published analyses from this data have examined specific factors influencing outcome. This study analyzes a comprehensive range of factors that may influence outcome from the time of listing through the peri- and postoperative period.
Methods:
A total of 42 pre-, peri- and posttransplant variables evaluated in 2982 pediatric recipients of a first liver transplant registered in SPLIT significant at the univariate level were included in multivariate models.
Results:
In the final model combining all baseline and posttransplant events, posttransplant complications had the highest relative risk of death or graft loss. Reoperation for any cause increased the risk for both patient and graft loss by 11 fold and reoperation exclusive of specific complications by 4 fold. Vascular thromboses, bowel perforation, septicemia, and retransplantation, each independently increased the risk of patient and graft loss by 3 to 4 fold. The only baseline factor with a similarly high relative risk for patient and graft loss was recipient in the intensive care unit (ICU) intubated at transplant. A significant center effect was also found but did not change the impact of the highly significant factors already identified.
Conclusions:
We conclude that the most significant factors predicting patient and graft loss at 6 months in children listed for transplant are posttransplant surgical complications.
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