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Outcomes following liver transplantation in young infants: Data from the SPLIT registry
Ajay K Jain1, Ravinder Anand2, Stacee Lerret3,4
1Saint Louis University, Saint Louis, Missouri, USA.
Insights
Pediatric liver transplantation (LT) outcomes are poorer for infants under 3 months and those under 5 kg, experiencing more complications and lower survival. Early LT and intensive post-transplant care may improve results.
Area of Science:
- Pediatric Hepatology and Gastroenterology
- Transplantation Science
- Clinical Outcomes Research
Background:
- Liver transplantation (LT) in pediatric populations is increasing.
- Understanding factors influencing successful pediatric LT is crucial for optimizing outcomes and guiding clinical decisions.
Purpose of the Study:
- To analyze pre-, intra-, and postoperative events in pediatric liver transplantation.
- To identify key contributors to successful outcomes in young liver transplant recipients.
- To guide transplant decision-making processes for pediatric patients.
Main Methods:
- Retrospective analysis of the SPLIT registry data for pediatric liver transplants performed between 2011 and 2018.
- Comparison of outcomes across defined age groups (0-<3 months, 3-<6 months, 6-<12 months, 1-<3 years) and weight categories (<5 kg, 5-10 kg, >10 kg).
- Analysis included 1033 pediatric patients.
Main Results:
- Infants aged 0 to <3 months and those weighing <5 kg exhibited higher rates of cholestatic disease, fulminant liver failure, and dependence on life support.
- These youngest and smallest recipients had significantly higher listing urgency (UNOS status 1a/1b), shorter wait times, and poorer survival rates (93.1% in Group A).
- Elevated international normalized ratio (INR) and bilirubin levels, higher PELD scores (≥40), increased postoperative hospital stays, rejection episodes, and non-anastomotic biliary strictures were observed in the youngest age group (Group A).
Conclusions:
- Infants aged 0 to <3 months and those weighing <5 kg represent a high-risk group requiring intensive care, facing greater complications, and experiencing lower survival post-liver transplantation.
- Proactive LT before reaching critical status (1a/1b) and aggressive postoperative management strategies are critical for improving outcomes in these vulnerable pediatric patients.
Abstract:
Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre-, intra-, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0-<3, 3-<6, 6-<12 months, and 1-<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5-10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1-3.9] and 16.7 [6.8-29.7] mg/dL) and those <5 kg (2.6 [1.8-3.4] and 13.5 [3.0-28.4] mg/dL). A pediatric end -stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.
