Factors associated with improved patient and graft survival beyond 1 year in pediatric liver transplantation

Abstract

With advances in surgical techniques, medical management, and more equitable allocation systems, children who receive a liver transplantation (LT) today can expect remarkable outcomes early after LT. However, beyond 1 year after transplant, attrition rates have not improved. We reviewed two

“Long‐term” is getting longer for children receiving liver transplantation grafts

“…Today, children are undergoing transplant in a sicker state than ever before, with higher Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease scores at the time of LT. [1,2] Furthermore, more patients with hepatic malignancies and inborn errors of metabolism are being given the opportunity for cure with LT. Focusing on pretransplant management has illuminated the critical importance of treatments to address malnutrition, reduce frailty, and improve post-LT recovery.…”

“…[6] Finally, it should be noted that the percentage of living donor LT (LDLT) has decreased in the recent era, from 17.3% to 15.5% overall. [1] Based on the Scientific Registry of Transplant Recipients report of all LTs in 2019 in the United States, only 5.3% of adults and 14.3% of children received a graft from a living donor (LD). [2] As shown in the publication by Squires et al [1] as well as in many previous pediatric outcome studies, graft survival outcomes are better with LDLT compared with those who have received a deceased donor graft.…”

“…In this issue, Squires et al report long‐term outcomes following LT in children. [ 1 ] They conclude that children undergoing LT in the recent era have improved graft survival despite an increased proportion of higher risk primary diagnoses and despite no significant reduction in the incidence of key complications, such as hepatic artery thrombosis (HAT).…”

“…Graft survival has improved in the recent era. [ 1 ] An important complication of LT associated with poor graft survival is the development of vascular complications. Interestingly, rates of HAT have remained unchanged over time.…”

“…[ 1 ] Based on the Scientific Registry of Transplant Recipients report of all LTs in 2019 in the United States, only 5.3% of adults and 14.3% of children received a graft from a living donor (LD). [ 2 ] As shown in the publication by Squires et al [ 1 ] as well as in many previous pediatric outcome studies, graft survival outcomes are better with LDLT compared with those who have received a deceased donor graft. Furthermore, the risk of HAT is lower with technical variant grafts.…”