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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Children undergoing early liver re-transplantation for primary non-function have improved survival
Michael E Rogers1,2, Aaron Delman3, Kathleen Campbell1,2
1Department of Pediatric Gastroenterology Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Early re-transplantation for pediatric liver transplant recipients with primary non-function (PNF) improves patient survival compared to those who keep their original graft. This finding offers crucial insights for managing PNF after liver transplantation (LT).
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Organ Transplantation Outcomes
Background:
- Primary non-function (PNF) after pediatric liver transplantation (LT) is linked to extended hospital stays, graft failure, and mortality.
- Limited data exists on the long-term outcomes for children relisted for LT due to PNF, especially those who recover graft function.
Purpose of the Study:
- To investigate the natural history and outcomes of pediatric LT recipients relisted for PNF.
- To identify risk factors for early re-transplantation and mortality in this cohort.
- To compare patient survival between early re-transplantation and survival with the original graft.
Main Methods:
- Analysis of the United Network of Organ Sharing (UNOS) database for pediatric LT recipients diagnosed with PNF from 2000-2020.
- Exclusion of patients over 21 years old and those receiving multiple organ transplants.
- Utilized logistic regression and Cox proportional hazard models to assess risk factors for early re-transplantation and mortality.
Main Results:
- Of 108 patients relisted for PNF, 76 underwent early re-transplantation, 25 survived with their original graft, and 7 died.
- High-risk EBV mismatch and elevated donor serum creatinine were associated with increased odds of early re-transplantation.
- Early re-transplantation was linked to a reduced risk of overall patient mortality (HR 0.27) compared to surviving with the original LT.
Conclusions:
- Early re-transplantation for PNF in pediatric liver transplant recipients is associated with improved patient survival.
- This strategy offers a better outcome than conservative management for patients who survive with their original graft post-PNF.
Background:
Primary non-function (PNF) in the early post-LT period in children leads to prolonged hospitalization, high graft loss, and significant mortality. However, there is a paucity of data available on the natural history of children relisted for LT due to PNF, including those who recover graft function and survive with their original allograft.
Methods:
We interrogated the United Network of Organ Sharing (UNOS) database for pediatric LT recipients who were relisted with a primary diagnosis of PNF from 2000 to 2020. Patients >21-year-old and multiple organ transplants were excluded. Logistic regression and Cox proportional hazard models were employed to identify risk factors for early re-transplantation (within 30 days of relisting) and mortality after adjusting for baseline clinical characteristics.
Results:
One hundred and eight patients were relisted for LT for PNF during the study period. Twenty-five patients survived beyond 30 days from relisting with their original LT, 76 underwent early re-transplantation, and 7 did not survive. Having a high-risk EBV mismatch (OR 2.03, 95% CI 0.66-6.27) and an elevated donor serum creatinine (OR: 2.19, 95% CI 0.54-8.84) were associated with increased odds of a patient requiring early re-transplantation. Donor characteristics including age, final total bilirubin, final AST/ALT, and final serum sodium, as well as vasopressor use prior to procurement, were not associated with increased odds of early re-transplantation (p > 0.05). Operative characteristics including allograft type and cold-ischemia time were also not associated with early re-transplantation (p > 0.05). Patients undergoing early re-transplantation showed a trend toward improved 1-year graft survival (69% vs 55%, p = 0.24). On multivariable Cox proportional hazards modeling, early re-transplantation was associated with reduced risk of overall patient mortality compared to those who survived with their original LT (HR 0.27, 95% CI 0.12-0.67).
Conclusion:
Early re-transplantation for PNF is associated with improved patient survival compared with patients who survive with their original LT.
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