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Prognosis of Children Undergoing Liver Transplantation: A 30-Year European Study
Ulrich Baumann1,2,3,4,5,6, Vincent Karam4,5, René Adam4,5
1Hannover Medical School, Divisions of Paediatric Gastroenterology and Hepatology, Department for Paediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany.
Insights
Pediatric liver transplants (PLT) have significantly improved survival rates, reaching 86% at 5 years. While early outcomes remain a challenge, PLT is a successful treatment for end-stage liver disease in children.
Area of Science:
- Hepatology and Transplant Surgery
- Pediatric Gastroenterology
- Clinical Outcomes Research
Background:
- The European Liver Transplant Registry (ELTR) has tracked pediatric liver transplant (PLT) data since 1968.
- Analysis focuses on patient outcomes and identifies long-term survival predictors.
- Data spans three eras: pre-2000, 2000-2009, and post-2010.
Discussion:
- Survival rates have markedly improved over time, from 74% in the early era to 86% currently.
- Congenital biliary and metabolic diseases are primary indications for PLT.
- Infection and graft primary nonfunction are leading causes of mortality.
Key Insights:
- Patient survival at 5 years is 86% overall and 97% for those surviving the first year post-transplant.
- Earlier eras saw lower survival rates (74%), improving to 85% in the current era.
- While historically low-volume centers had poorer outcomes, this is no longer significant in the current era.
Outlook:
- Pediatric liver transplantation is a highly successful treatment for end-stage liver disease.
- Focus on improving outcomes in the early postoperative period is crucial for further advancements.
- Continued data collection and analysis are essential for refining transplant protocols.
Objectives:
The European Liver Transplant Registry has been collecting data on virtually all pediatric liver transplant (PLT) procedures in Europe since 1968. We analyzed patient outcome over time and identified parameters associated with long-term patient outcome.
Methods:
Participating centers and European organ-sharing organizations provided retrospective data to the European Liver Transplant Registry. To identify trends, data were grouped into consecutive time spans: era A: before 2000, era B: 2000 to 2009, and the current era, era C: since 2010.
Results:
From June 1968 until December 2017, 16 641 PLT were performed on 14 515 children by 133 centers. The children <7 years of age represented 58% in era A, and 66% in the current era (P <.01). The main indications for PLT were congenital biliary diseases (44%) and metabolic diseases (18%). Patient survival at 5 years is currently 86% overall and 97% in children who survive the first year after PLT. The survival rate has improved from 74% in era A to 83% in era B and 85% in era C (P <.0001). Low-volume centers (<5 PLT/year) represented 75% of centers but performed only 19% of PLT and were associated with a decreased survival rate. In the current era, however, survival rates has become irrespective of volume. Infection is the leading cause of death (4.1%), followed by primary nonfunction of the graft (1.4%).
Conclusions:
PLT has become a highly successful medical treatment that should be considered for all children with end-stage liver disease. The main challenge for further improving the prognosis remains the early postoperative period.
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