Long‐term outcomes and predictors in pediatric liver retransplantation

Abstract

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.

Prognostic Factors in Pediatric Early Liver Retransplantation

“…In our study, since 1992, in 4.4% of LTs an eRe‐LT was necessary. In 67% of the patients, vascular complications led to the need for eRe‐LT, whereas in the remaining 33% the cause was PNF, similar to reports in other pediatric series …”

“…In 67% of the patients, vascular complications led to the need for eRe-LT, whereas in the remaining 33% the cause was PNF, similar to reports in other pediatric series. (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.…”

Identifying the Prognosis Factors in Death after Liver Transplantation via Adaptive LASSO in Iran

“…In a study about complications and mortality after liver transplantation, both univariate and multivariate analyses revealed a significant association between vascular complication and mortality of recipients [23]. As another result of the current study, like the other studies, we found that PTLD can increase the risk of death [24, 25]. And finally in contrast to our study, factors like the recipient's age, comorbidity disease, previous abdominal surgery, and MELD were reported as death risk factors after transplantation [2, 14, 26].…”

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

“…The condition worsens with time in a large proportion of the cases and may lead to life‐threatening conditions and the need for surgery (including re‐transplantation or a possible portosystemic shunt). This fact questions the current typical strategy (conservative management until unmanageable complications arise) given that late surgery/transplantation in these patients carry a known high risk of suboptimal outcomes …”