20‐ to 25‐year patient and graft survival following a single pediatric liver transplant—Analysis of the United Network of Organ Sharing database: Where to go from here

Abstract

To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age (P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age (P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age (P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection.

Pediatric length‐of‐stay index following liver transplantation

“…For example, while PELD and MELD scoring systems have led to a drastic decrease in mortality, it has been shown that their implementation has actually led to increased costs and that the score alone is not a perfect predictor of post‐transplantation complications 5‐8 . Meanwhile, other variables have been shown to be associated with complications following surgery and, in particular, the post‐transplant LOS in the hospital 9‐13 . Importantly, a longer stay in the hospital following a pediatric liver transplant has been directly associated with worse outcomes, more complications, and subsequently higher costs 14 .…”

Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation—Analysis of 858 Transplantations in 38 Years

“…This stands in contrast to most studies, which-if at all-have found early infancy to be a risk factor for impaired survival [6,8,11,25,26], or seen no influence at all [27]. One study found superior results for patient and graft survival in small infants [13], and two studies also found older patients at a higher risk of mortality [25,28]. The better outcome of infants in our center may be related to comparably longer experience in partial and split liver transplantation in our center, both in surgical and pediatric care.…”

“…The analysis of factors influencing graft survival revealed a lower risk for graft loss in the group of patients between 6 and 12 years of age. As age groups have been defined differently, a direct comparison is difficult, but some other studies have seen this age group rather as a risk factor for an unfavorable outcome [18,28] and liver recipients in infancy at a higher risk of graft loss [30]-which we could not reproduce in our analysis.…”

Orthotopic liver transplant in the pregnant recipient: A systematic review of preoperative management and maternal and fetal outcomes

“…Women constitute 37% of patients who have had liver transplantation, with about 12% being of reproductive age (18‐49 years old). Another 5% are pediatric female liver transplant recipients, who have > 80% survival into adulthood and thus may likely consider pregnancy 5,6 …”

“…5 Women constitute 37% of patients who have had liver transplantation, with about 12% being of reproductive age (18-49 years old).Another 5% are pediatric female liver transplant recipients, who have > 80% survival into adulthood and thus may likely consider pregnancy. 5,6 Since the first pregnancy in a liver transplant recipient in 1978, outcomes for both mother and fetus have greatly improved. Recent studies report a 20-year maternal survival rate of 53% and a live birth rate of 75% 7,8 in patients who became pregnant after liver transplantation.…”