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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Three decades' analysis of pediatric liver transplantation outcomes reveals limited long-term improvements
Syed Bakhtiyar1, Anjay Batra2, Tahir Malik2
1Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Pediatric liver transplant recipients have improved 1-year survival, but long-term outcomes remain unchanged. Long-term immunosuppression side effects, including malignancy and infection, are the leading causes of death, necessitating improved management strategies.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Immunosuppression Management
Background:
- Significant advancements have increased 1-year survival rates for pediatric liver transplant recipients from 78% (1987-1990) to 95% (2011-2017).
- Despite improved short-term survival, long-term outcomes for pediatric liver transplant survivors have not shown similar progress.
- This disparity necessitates an analysis of long-term survival trends and associated causes of mortality.
Purpose of the Study:
- To evaluate long-term survival trends in pediatric liver transplant recipients who survive beyond one year post-transplantation.
- To identify changes in causes of death among long-term survivors over three decades.
- To inform strategies for improving long-term management and outcomes in this patient population.
Main Methods:
- Analysis of 13,753 pediatric patients undergoing liver transplantation between 1987 and 2017, focusing on those surviving at least 1 year.
- Stratification of the study period into six distinct eras to assess temporal trends.
- Application of Kaplan-Meier survival analysis and multivariable Cox regression to analyze time-to-event data.
Main Results:
- No statistically significant improvements in long-term survival were observed among 1-year survivors over the study period.
- Infections as a cause of death decreased significantly from 20.6% (1987-1990) to 5.6% (2011-2017) (p=0.01).
- Malignancy-related deaths significantly increased from 10.6% (1987-1990) to 22.2% (2011-2017) (p=0.04).
Conclusions:
- Pediatric liver transplant recipients surviving the first year show no significant improvement in long-term survival despite advances in short-term outcomes.
- Long-term complications of immunosuppression, particularly malignancy and infection, remain the primary causes of mortality.
- Enhanced long-term immunosuppression management strategies are crucial for improving survival in pediatric liver transplant recipients.
Background:
The aim of this study was to assess improvements in long-term survival of pediatric patients after liver transplantation by analyzing outcomes in transplant recipients who survived beyond 1 year after transplantation. There has been a marked increase in the 1-year survival of pediatric patients, from 78% in transplant recipients between 1987 and 1990 to 95% in transplant recipients between 2011 and 2017. The long-term outcomes have not seen a similar trend, creating a disparity that warrants analysis.
Methods:
We analyzed 13 753 pediatric patients who survived for 1 year after receiving orthotopic liver transplantation between 1987 and 2017. The study period was divided into six eras. Outcomes were analyzed using the Kaplan-Meier method for time-to-event analysis, and multivariable Cox regression.
Results:
There were no significant gains in long-term outcomes among 1-year survivors over the past three decades. Log-rank tests for equality of survivor functions between each era and 1987-1990 were not statistically significant. Cause of death analysis revealed that although infections caused 20.6% of deaths in patients transplanted between 1987 and 1990, this number dropped to 5.6% in those transplanted between 2011 and 2017 (p = .01). Malignancy caused 10.6% of deaths in 1987-1990 but caused 22.2% of the deaths in 2011-2017 (p = .04).
Conclusion:
Despite the gratifying gains in short-term survival of pediatric patients, 1-year survivors have no significant improvements in long-term survival after undergoing a liver transplantation. Long-term sequelae of immunosuppression, such as malignancy and infection, continue to be the most common causes of death. This study highlights the necessity for better long-term management of immunosuppression.
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