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Published on: August 17, 2022
Effect of Recipient Age on Perioperative Complications after Pediatric Liver Transplantation: A Single-Center
Akira Katayama1, Satoshi Kimura2, Takashi Matsusaki3
1Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Insights
Recipient age impacts serious complications after pediatric living donor liver transplantation (LDLT). Non-infant recipients had more complications, but Graft-to-Recipient Weight Ratio (GRWR) was the key factor, not recipient age itself.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Gastroenterology
Background:
- Recipient age is a potential factor influencing outcomes in pediatric liver transplantation.
- Previous studies have not clearly defined the impact of recipient age on serious complications following pediatric living donor liver transplantation (LDLT).
Purpose of the Study:
- To investigate how recipient age influences the incidence of serious postoperative complications in pediatric LDLT.
- To identify independent risk factors for severe complications after pediatric LDLT.
Main Methods:
- Retrospective analysis of 42 pediatric patients undergoing LDLT.
- Patients were categorized into infant (<1 year) and non-infant (≥1 to ≤15 years) groups.
- Complications were assessed using the Clavien-Dindo classification; multivariate Cox regression analysis was employed.
Main Results:
- The incidence of Clavien-Dindo grade ≥ III complications was significantly higher in the non-infant group (46.2%) compared to the infant group (12.5%).
- Multivariate analysis identified Graft-to-Recipient Weight Ratio (GRWR) as an independent predictor of severe complications (HR 0.62, p=0.03).
- Recipient age (infant vs. non-infant) was not an independent predictor of severe complications (HR 0.84, p=0.68).
Conclusions:
- While non-infant recipients experienced more severe complications, this was primarily associated with Graft-to-Recipient Weight Ratio (GRWR), not recipient age.
- GRWR is a critical factor influencing postoperative complication rates in pediatric LDLT.
- These findings highlight the importance of graft size relative to recipient size in pediatric liver transplantation outcomes.
Abstract:
It has not been clear how recipient age affects the incidence of serious complications after pediatric living donor liver transplantation (LDLT). We investigated the records of 42 pediatric patients receiving LDLT, dividing our sample into two groups: the infant group (aged < 1 year) and the non-infant group (aged ≥ 1 year and ≤15 years). The primary outcome was postoperative complications assessed using the Clavien-Dindo classification. Multivariate analysis using the Cox regression model was applied to adjust for confounding factors in assessing the incidence of Clavien-Dindo grade ≥ III (C-D ≥ III) complications. The incidence of C-D ≥ III complications was higher in the non-infant group (46.2%) than in the infant group (12.5%) (odds ratio 6.00, 95% confidence interval [CI] 1.13-31.88, p=0.03). In multivariate analysis using the Cox regression model, the Graft-to-Recipient Weight Ratio (GRWR) was independently associated with the incidence of C-D ≥ III complications (hazard ratio [HR] 0.62, 95%CI 0.40-0.95, p=0.03), but being an infant was not (HR 0.84, 95%CI 0.35-1.98, p=0.68). In conclusion, the incidence of C-D ≥ III complications was higher in the non-infant group than in the infant group, but this was largely a function of GRWR: multivariate analysis revealed that GRWR was independently associated with complications.
