Liver retransplantation in children: The Atlanta experience

Heffron, Thomas G.; Pillen, Todd; Smallwood, Gregory; Henry, Stuart; Sekar, Sundari; Solís, David Pérez; Casper, Katie; Fasola, Carlos G.; Romero, René

doi:10.1111/j.1399-3046.2010.01304.x

Cited by 18 publications

(28 citation statements)

References 20 publications

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“…Literature reports concerning pediatric re-LTX indicate a clear reduction of graft and patient survival after re-LTX in comparison with primary LTX (4,5,7,12,14,15). However, in contrast, two recent small single-center studies showed similar outcomes after primary LTX and re-LTX (6,16). There are also differing results concerning the impact of the re-transplantation time point.…”

Section: Discussionmentioning

confidence: 98%

Outcome of liver re‐transplantation in children—Impact and special analysis of early re‐transplantation

Herden

Ganschow²,

Grabhorn

et al. 2014

Pediatric Transplantation

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In case of graft failure, re-LTX is the only life-saving option but it has been associated with inferior results. This study analyzes the outcome following pediatric re-LTX with a main focus on the timely relation between initial transplant and re-LTX. All pediatric LTX at our institution between 2000 and 2010 divided into patients with primary LTX and patients undergoing re-LTX early (≤30 days) or late (>30 days) after previous LTX were analyzed. Two hundred and ninety-eight primary LTX(79%), 33 early (9%), and 46 late (12%) re-LTX were performed. Patient/graft survival was significantly worse for children undergoing early re-LTX compared to primary LTX and late re-LTX (p = 0.024/0.001 and p = 0.015/0.03). One-/five-yr graft survival rates were 66%/49% for early re-LTX compared to 86%/76% for late re-LTX and 90%/74% for primary LTX. The inferior results in children undergoing early re-LTX were due to events occurring in the first six months with similar survival thereafter. No difference in outcome was evident after adjustment of the groups for high-urgency status. Outcome was excellent for primary LTX and late re-LTX, supporting late re-LTX in children. Early re-LTX takes an elevated risk of early graft loss and patient death; however, beyond the early postoperative period, the outcome was comparable.

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Section: Discussionmentioning

confidence: 98%

Outcome of liver re‐transplantation in children—Impact and special analysis of early re‐transplantation

Herden

Ganschow²,

Grabhorn

et al. 2014

Pediatric Transplantation

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“…Several previous studies of retransplantation conducted in single centers as well as using UNOS and SPLIT databases have reported protective and risk factors . A multivariate analysis of the UNOS database described number of retransplants, race, hospitalization in the ICU, weight, creatinine levels, bilirubin levels, donor age, and cold ischemia time as risk factors in retransplantation .…”

mentioning

confidence: 99%

“…A study using SPLIT retransplantation data found associations between survival at two yrs and donor age, use of a technical variant allograft, and INR at retransplant . Single‐center studies have also reported associations between survival and patient age, presence of cholestasis, congenital abnormalities, pretransplant ALT, donor age, donor cardiac death, regional vs. national allocation, and percent blood transfusion during transplant . A prognostic scoring tool constructed by Davis et al includes life support at retransplant, split liver graft, cholestasis or paucity of bile ducts, and congenital abnormalities as risk factors and older patient age and an indication of acute rejection as protective factors for retransplant patients.…”

mentioning

confidence: 99%

Long‐term outcomes and predictors in pediatric liver retransplantation

Dreyzin

Lunz

Venkat

et al. 2015

Pediatric Transplantation

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Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan-Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had "early" (≤ 30 days after primary transplant) and "late" retransplants. Eighty-four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five-yr follow-up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long-term immunosuppressant morbidity remains an opportunity for improvement.

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“…Although over time there has been a trend toward better survival in patients undergoing eRe‐LT, results are still significantly worse than after a first transplantation . Also, results in patients undergoing eRe‐LT are consistently worse than in those who undergo late re‐LT, and prognosis in the eRe‐LT patients is also worse than in those with the other classical indication for urgent LT: acute liver failure …”

Section: Discussionmentioning

confidence: 99%

“…(6)(7)(8)(9)(10)13,(16)(17)(18) Although over time there has been a trend toward better survival in patients undergoing eRe-LT, results are still significantly worse than after a first transplantation. (1,5,7,16,17,19,20) Also, results in patients undergoing eRe-LT are consistently worse than in those who undergo late re-LT, and prognosis in the eRe-LT patients is also worse than in those with the other classical indication for urgent LT: acute liver failure. (17) In a large single-center series of children undergoing LT, Venick et al found that eRe-LT was an independent prognostic factor for poor outcome.…”

Section: Original Article | 533mentioning

confidence: 99%

Prognostic Factors in Pediatric Early Liver Retransplantation

Reyes¹,

Halac²,

Aredes³

et al. 2020

Liver Transpl

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The most common indications for early liver retransplantation (eRe‐LT) are vascular complications and primary nonfunction (PNF). These patients are usually in a critical clinical condition that can affect their chances of survival. In fact, the survival of these patients is usually lower compared with the patients undergoing a first transplant. To the best of our knowledge, no specific series of pediatric patients undergoing eRe‐LT has been published to date. Therefore, the aim of this study is to report the results of eRe‐LT and to analyze factors potentially related to success or failure. Our work is of a retrospective cohort study of patients who underwent eRe‐LT at the Juan P. Garrahan Pediatric Hospital of Buenos Aires, Argentina, between May 1995 and December 2018 (n = 60). Re‐LT was considered early when performed ≤30 days after the previous LT. A total of 40 (66.7%) patients were enrolled due to vascular causes and 20 (33.3%) were enrolled because of PNF. Of all the relisted patients, 36 underwent eRe‐LT, 14 died on the waiting list, and 10 recovered without eRe‐LT. A total of 23 (63.9%) patients died after eRe‐LT, most of them due to infection‐related complications. Survival rates at 1 and 5 years were 42.4% and 33.9%, respectively. On univariate logistic regression analysis, Pediatric End‐Stage Liver Disease (PELD)/Model for End‐Stage Liver Disease (MELD) scores, transplant era, and advanced life support at eRe‐LT were found to be related to 60‐day mortality. However, on multivariate analysis, era (odds ratio [OR], 9.3; 95% confidence interval [CI], 1.19‐72.35; P = 0.033) and PELD/MELD scores (OR, 1.07; 95% CI, 1‐1.14; P = 0.036) were significantly associated with 60‐day patient mortality. This study found that the level of acuity before retransplant, measured by the requirement of advanced life support and the PELD/MELD score at eRe‐LT, was significantly associated with the chances of post–eRe‐LT patient survival.

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Liver retransplantation in children: The Atlanta experience

Cited by 18 publications

References 20 publications

Outcome of liver re‐transplantation in children—Impact and special analysis of early re‐transplantation

Outcome of liver re‐transplantation in children—Impact and special analysis of early re‐transplantation

Long‐term outcomes and predictors in pediatric liver retransplantation

Prognostic Factors in Pediatric Early Liver Retransplantation

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