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Does body weight below 6 kg modify survival of infants after liver transplant? Complete National Transplant Registry
Przemyslaw Maruszewski1, Almudena L Vilchez Monge2, Marek Stefanowicz1
1Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland.
Insights
Infant liver transplantation (LT) outcomes are not negatively impacted by recipient body weight under 6 kg. This study found no significant difference in failure-free survival for infants undergoing LT, regardless of their pre-transplant weight.
Area of Science:
- Pediatric surgery
- Hepatology
- Transplantation immunology
Background:
- Liver transplantation (LT) is a critical treatment for end-stage liver disease in infants.
- Assessing factors influencing LT outcomes in low-weight infants is crucial for surgical decision-making.
- Infant recipient body weight is a potential factor affecting graft and patient survival post-LT.
Purpose of the Study:
- To evaluate the impact of infant recipient body weight at primary liver transplantation (LT) on recipient and graft survival rates.
- To analyze national data from Poland to determine the influence of pre-transplant body weight on LT outcomes in infants.
- To identify whether a body weight threshold affects survival post-LT.
Main Methods:
- Retrospective cohort study of 142 infants (<1 year, <10 kg) undergoing primary, isolated LT between 2001-2017 in Poland.
- Patients divided into two groups: Group I (≤6.0 kg) and Group II (6.1-9.9 kg).
- Multivariable Cox regression analysis used to assess the independent impact of body weight on patient and graft survival.
Main Results:
- No statistically significant impact of body weight ≤6.0 kg on 1-year failure-free survival was observed (p=0.063).
- Infants with body weight ≤6.0 kg experienced longer post-LT intensive care unit and hospital stays.
- Univariate predictors of mortality or retransplantation included low body weight, high PELD score, urgent LT, deceased donor graft, and post-LT complications.
Conclusions:
- Recipient body weight ≤6.0 kg does not independently negatively impact failure-free survival 1 year post-LT.
- Liver transplantation in infants with end-stage liver disease should proceed based on medical indications and urgency when a suitable donor is available.
- The findings support performing LT in low-weight infants when necessary, irrespective of minor weight differences below 10 kg.
Objective:
To determine the impact of infant recipient body weight at primary liver transplantation (LT) on both recipient and graft survival rates in complete national data from Poland.
Methods:
We conducted a single-center, retrospective cohort study including 142 LT recipients below 1 year of age with body weights below 10 kg who received primary and isolated LT between 2001 and 2017. Patients were divided into two study groups according to body weight at the time of LT: (1) Group I (≤6.0 kg, 32 patients) and (2) Group II (6.1-9.9 kg, 110 patients). Independent impact of body weight on patient and graft survival were assessed using survival curves and a multivariable Cox regression analysis. The univariate predictors of mortality or retransplantation at 1 year post-LT were recipient body weight of ≤6 kg at transplantation, pediatric end-stage liver disease score, urgent LT, graft from deceased donor, cold ischemia time, post-LT hepatic artery thrombosis, and post-LT dialysis.
Results:
No statistically significant impact of body weight ≤6 kg on 1-year failure-free survival was found based on the multivariable analysis (p = 0.063). Body weight ≤6 kg was associated with longer post-LT intensive care unit and post-LT hospital stays (p = 0.013 and 0.025, respectively).
Conclusions:
Since no evidence of independent negative impact of recipient body weight ≤6 kg on failure-free survival 1 year post-LT was found, LT in infants with end-stage liver disease in Poland should be performed according to medical indications and urgency when an appropriate donor is available.
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