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Predicting early outcomes of liver transplantation in young children: The EARLY study
Rashid Alobaidi1, Natalie Anton1, Dominic Cave1
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta T6G 1C9, Canada.
Insights
This study identified key factors influencing early outcomes in pediatric liver transplants. Higher antithrombin levels post-transplant were linked to fewer complications, while graft type and surgeon experience impacted results.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Clinical Outcomes Research
Background:
- Liver transplantation in children under 3 years presents unique challenges.
- Identifying modifiable factors is crucial for improving early post-transplant outcomes.
Purpose of the Study:
- To identify potentially modifiable predictors of early outcomes in pediatric liver transplant recipients younger than 3 years.
- To analyze the association between graft types, perioperative factors, and complications.
Main Methods:
- Retrospective chart review of 65 children (<3 years) undergoing liver transplantation from 2005-2015.
- Analysis of pre-specified predictor variables and outcomes using univariate and multiple logistic/linear regressions.
- Outcomes included mortality, re-operation, hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), and severe complications.
Main Results:
- Split/reduced grafts and living related donors were associated with lower rates of HAT and thrombosis compared to whole liver grafts.
- Higher postoperative antithrombin levels (day 2-5) correlated with fewer complications and reduced ventilator days.
- Surgeon and graft type influenced ventilator days and severe complications.
Conclusions:
- Graft selection (split/reduced or living related donor) and surgeon experience are significant factors in early pediatric liver transplant outcomes.
- Maintaining adequate postoperative antithrombin levels may mitigate complications.
- These findings offer insights for optimizing care in this vulnerable population.
Aim:
To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years.
Methods:
This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015. Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form. Associations between potential predictor variables and outcomes were determined using univariate and multiple logistic [odds ratio (OR); 95%CI] or linear (effect size, ES; 95%CI) regressions.
Results:
There were 65 children, of mean age 11.9 (SD 7.1) mo and weight 8.5 (2.1) kg, with biliary-atresia in 40 (62%), who had a living related donor [LRD; 29 (45%)], split/reduced [21 (32%)] or whole liver graft [15 (23%)]. Outcomes after liver transplant included: ventilator-days of 12.5 (14.1); pediatric intensive care unit mortality of 5 (8%); re-operation in 33 (51%), hepatic artery thrombosis (HAT) in 12 (19%), portal vein thrombosis (PVT) in 11 (17%), and any severe complication (HAT, PVT, bile leak, bowel perforation, intraabdominal infection, retransplant, or death) in 32 (49%) patients. Predictors of the prespecified primary outcomes on multiple regression were: (1) HAT: split/reduced (OR 0.06; 0.01, 0.76; P = 0.030) or LRD (OR 0.16; 0.03, 0.95; P = 0.044) vs whole liver graft; and (2) ventilator-days: surgeon (P < 0.05), lowest antithrombin (AT) postoperative day 2-5 (ES -0.24; -0.47, -0.02; P = 0.034), and split/reduced (ES -12.5; -21.8, -3.2; P = 0.009) vs whole-liver graft. Predictors of the pre-specified secondary outcomes on multiple regression were: (1) any thrombosis: LRD (OR 0.10; 0.01, 0.71; P = 0.021) or split/reduced (OR 0.10; 0.01, 0.85; P = 0.034) vs whole liver graft, and lowest AT postoperative day 2-5 (OR 0.93; 0.87, 0.99; P = 0.038); and (2) any severe complication: surgeon (P < 0.05), lowest AT postoperative day 2-5 (OR 0.92; 0.86-0.98; P = 0.016), and split/reduced (OR 0.06; 0.01, 0.78; P = 0.032) vs whole-liver graft.
Conclusion:
In young children, whole liver graft and surgeon was associated with more complications, and higher AT postoperative day 2-5 was associated with fewer complications early after liver transplantation.
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