Long-term survival expectancy after liver transplantation in children

Migliazza, Lucia; Santamarı́a, Manuel; Murcia, J; Gámez, M; Clavijo, Julio; Camarena, C.; Hierro, Loreto; Frauca, E; Vega, A. de la; Díaz, María Eugenia López-Jacoiste; Jara, Paloma; Tovar, Juan A.

doi:10.1016/s0022-3468(00)80003-2

Cited by 62 publications

(38 citation statements)

References 6 publications

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“…This study represents one of the largest single‐center pediatric liver transplant experiences regarding BA. This result compares favorably with the 10‐year pediatric survival after OLT, which ranged from 61 to 90% 8, 19–22. The 90% survival rate at 10 years reported by Wallot et al22 is likely explained by the patient selection in this study, which only took into account those who survived with their original graft at least 3 months after a 1st OLT.…”

Section: Discussionsupporting

confidence: 63%

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Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center

et al. 2005

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The aim of this study was to review our experience in orthotopic liver transplantation (OLT) for biliary atresia (BA) in children and analyze the survival and prognostic factors, and long-term outcome. We reviewed 332 OLTs performed in 280 children between the years 1986 and 2000. Univariate and multivariate analysis were performed on patient and graft survivals according to recipients' and donors' characteristics as well as intraoperative data. The long-term outcome among the 80 children living at 10 years after OLT was studied according to growth, immunosuppressive therapy, and liver and renal functions. Liver graft status was eventually documented by liver biopsy. Status of rehabilitation was assessed by reviewing school performance and employment. Overall patient survival rates at 1, 5, and 10 years were 85, 82, and 82%, respectively, and the corresponding overall graft survival rates were 77, 73, and 71%. In the multivariate analysis, we identified 4 independent prognostic factors: polysplenia syndrome (P ‫؍‬ .03), United Network for Organ Sharing (UNOS) status (P ‫؍‬ .05), donor's age (P ‫؍‬ .01), and perioperative surgical complications (P ‫؍‬ .03). At 10 years after transplant, 80 children were alive and had normal growth rates. Liver histology was abnormal in 73% of these long-term survivors, mainly due to chronic rejection and centrilobular fibrosis. A total of 63 of the 80 children attended normal school and in 55 children (69%) school performance was not delayed. In conclusion, we discovered that a good long-term survival could be achieved after liver transplantation for BA, with a 82% survival rate at 10 years with normal scholastic studies in the majority of recipients. (Liver Transpl 2005;11: 152-160.)

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Section: Discussionsupporting

confidence: 63%

“…BA is the most common indication for pediatric liver transplantation, representing at least 50% of all cases in most series 4, 8. The success of OLT obtained in the last 2 decades has led to a rapid increase in the number of children waiting for OLT.…”

mentioning

confidence: 99%

Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center

et al. 2005

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“…( Moreover, in comparison to other age groups, children below-1-year-old had the lowest survival rate, which is in agreement with other studies, including the one performed by Venick; however, this finding had no significant effect in the Cox model (19, 20). Similar to most previous studies, Wilson’s disease and biliary atresia were the most prevalent indications leading to transplantation in the present study (8, 16). Furthermore, in line with the study conducted by Wallot in Europe, the survival rate of the patients who had undergone liver transplantation due to malignancies was significantly lower than other patients (17).…”

Section: Discussionsupporting

confidence: 91%

“…In the present study, 1, 5, and 10-year survival of the patients was 73%, 66%, and 66%, respectively, which is lower than the survival rate reported in other studies. For instance, Milglizza conducted a study in Spain and reported the patients’ 1-, 5-, and 10-year survival as 80%, 74%, and 74%, respectively (16). In spite of the fact that we only have a 12-year experience with liver transplantation among this group of patients, the survival rate has increased in our center through the recent years (2008-2011).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival and Its Related Factors in Pediatric Liver Transplant Recipients of Shiraz Transplant Center, Shiraz, Iran in 2012

et al. 2013

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BackgroundLiver transplantation is considered as the standard treatment for both children and adults with end-stage liver diseases. Using this method, children who have no chance for life can live a much longer life .Shiraz Transplant Center is the major pediatric liver transplant center in Iran. Therefore, determining patients’ survival and its effective factors can help clinical programming for increasing such patients’ survival after liver transplantation.ObjectivesThe present study aimed to investigate the survival of patients below-18-years-old undergoing liver transplantation and the factors affecting their survival.Patients and MethodsThe present historical cohort study was conducted on 392 patients below-18-year-sold who had undergone liver transplantation for the first time in the Namazi hospital liver transplant center, Shiraz, Iran between 2000 and 2011. In this study, 1-, 3-, 5-, and 10-year survival of the patients was assessed using Kaplan-Meier and life table methods. The effect of factors related to the recipients, donors, and the transplantation process on the patients’ survival was also investigated.ResultsAccording to the results, 1, 3, 5 and 10-year survival of patients was 73%, 67%, 66%, and 66%, respectively. Besides, 1 ,3, 5, and 10-year survival of the patients who survived 1 and 3 months after the transplantation was 84%, 78%, 77%, and 77% and 89%, 82%, 81%, and 81%, respectively. In the univariate analysis, age, patients’ weight at transplantation, initial diagnosis, PELD/MELD score, existence of post-transplant complications, and year of transplantation were found to be effective factors on the patients’ survival. In the multivariate analysis, only the type of graft, PELD/MELD score, and existence of post-transplant complications were the prognostic variables.ConclusionsIn this study, the patients’ survival rate was 73%, which is quite low compared to the survival rate reported in other studies. Although we only have a 12-year experience with pediatric liver transplantation, the survival rate has increased in our center through the recent years (2008-2011). However, the survival rate of the patients who had survived 3 months after the transplantation was 89% which is comparable to other studies. Overall, cholestatic diseases (biliary atresia was the most prevalent), type of transplantation (split), PELD/MELD score > 20, and existence of post-transplant complications increased the risk of death after the transplantation.

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“…Because primary infection is a much more potent risk factor than reactivation infection, EBV seronegative compared to seropositive recipients, are five to seven times more likely to develop clinically important EBV infection and PTLD (15, 16). PTLD has been a leading cause of death beyond the immediate post-operative period (17). …”

Section: Morbidity Of Long-term Immunosuppressionmentioning

confidence: 99%

Long-term management of immunosuppression after pediatric liver transplantation: is minimization or withdrawal desirable or possible or both?

Feng

2008

Current Opinion in Organ Transplantation

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Purpose of Review-The aim of this review is to review available data regarding the risks and benefits of indefinite immunosuppression versus attempted immunosuppression withdrawal for children who have undergone liver transplantation.Recent Findings-Emerging data suggest that conventional immunosuppression practices may well be responsible for a substantial proportion of the long-term mortality and morbidity burden borne by pediatric liver transplant recipients. The cumulative risk of chronic kidney disease, infection, malignancy, and cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia appear to threaten the health and well-being of children more than that of acute or chronic allograft rejection. In parallel, single center experiences have suggested that gradual immunosuppression withdrawal can be done safely with higher success rates in pediatric compared to adult liver transplant recipients. The coalescence of these two data streams has engendered substantial interest in systematic exploration of the safety and efficacy of immunosuppression withdrawal in conjunction with a vigorous scientific effort to elucidate an immunologic signature predictive of succesful withdrawal.Summary-There is a concerted effort within the transplant community to identify biomarkers that can accurately predict the success of immunosuppression withdrawal after liver transplantation. Freedom from lifelong immunosuppression is likely to yield considerable benefit, particularly for children who face the longest lifetime horizons.

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Long-term survival expectancy after liver transplantation in children

Cited by 62 publications

References 6 publications

Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center

Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center

Long-Term Survival and Its Related Factors in Pediatric Liver Transplant Recipients of Shiraz Transplant Center, Shiraz, Iran in 2012

Long-term management of immunosuppression after pediatric liver transplantation: is minimization or withdrawal desirable or possible or both?

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