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One Thousand Pediatric Liver Transplants During Thirty Years: Lessons Learned

Robert S Venick1, Douglas G Farmer2, Jose R Soto2

  • 1Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.

Journal of the American College of Surgeons
|February 8, 2018
PubMed

Insights

This study of pediatric liver transplantation (pLTx) identified key factors influencing graft and patient survival. Understanding these predictors, like weight and renal function, can improve outcomes for children needing liver transplants.

Area of Science:

  • Pediatric Surgery
  • Transplantation Medicine
  • Hepatology

Background:

  • Pediatric liver transplantation (pLTx) is a critical treatment for pediatric liver failure.
  • This study analyzes the largest single-center experience in pLTx.
  • Focus is on identifying preoperative predictors for early graft and patient survival.

Purpose of the Study:

  • Identify unique preoperative predictors of early graft survival for primary pLTx (1°-pLTx).
  • Identify unique preoperative predictors of early graft survival for retransplantation (Re-pLTx).
  • Identify unique preoperative predictors of early patient survival.

Main Methods:

  • Retrospective analysis of isolated pLTx in patients ≤18 years.
  • Analysis of 28 demographic, laboratory, and perioperative variables.
  • Log-rank test and Cox's proportional hazards model for univariate and multivariate analyses.

Main Results:

  • 806 children underwent 1,016 pLTx between 1984-2017; median follow-up 12 years.
  • Graft survival rates at 20 years: 53%; patient survival rates at 20 years: 69%.
  • Predictors for 1°-pLTx graft survival: weight, era, renal replacement therapy. Predictors for Re-pLTx graft survival: warm ischemia time, time between transplants. Patient survival predictors: renal function, mechanical ventilation, liver disease etiology.

Conclusions:

  • Largest single-center pLTx experience with extensive follow-up.
  • Key graft survival predictors: weight, renal function, transplant era, ischemia time, time between transplants.
  • Patient survival influenced by renal function, ventilation, and liver disease etiology, aiding clinical decision-making.
Abstract

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