Outcomes After Liver Transplantation

Bucuvalas, John C.; Campbell, Kathleen; Cole, Conrad R.; Guthery, Stephen L.

doi:10.1097/01.mpg.0000226389.64236.dc

Cited by 29 publications

(14 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, the use of mycophenylate or induction agents may be unnecessary in infants given their very low risk of rejection and more risky because of the innate immaturity of their immune system. In all age groups however, potent immunosuppressive regimens have other drawbacks (18,20) besides risk for infection, including malignancy, metabolic adverse effects, growth failure and late renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

View full text Add to dashboard Cite

Rejection and infection are important adverse events after pediatric liver transplantation, not previously subject to concurrent risk analysis. Of 2291 children (<18 years), rejection occurred at least once in 46%, serious bacterial/fungal or viral infections in 52%. Infection caused more deaths than rejection (5.5% vs. 0.6% of patients, p < 0.001). Early rejection (<6 month) did not contribute to mortality or graft failure. Recurrent/chronic rejection was a risk in graft failure, but led to retransplant in only 1.6% of first grafts. Multivariate predictors of bacterial/fungal infection included recipient age (highest in infants), race, donor organ variants, bilirubin, anhepatic time, cyclosporin (vs. tacrolimus) and era of transplant (before 2002 vs. after 2002); serious viral infection predictors included donor organ variants, rejection, Epstein-Barr Virus (EBV) naivety and era; for rejection, predictors included age (lowest in infants), primary diagnosis, donor-recipient blood type mismatch, the use of cyclosporin (vs. tacrolimus), no induction and era. In pediatric liver transplantation, infection risk far exceeds that of rejection, which causes limited harm to the patient or graft, particularly in infants. Aggressive infection control, attention to modifiable factors such as pretransplant nutrition and donor organ options and rigorous age-specific review of the risk/benefit of choice and intensity of immunosuppressive regimes is warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

View full text Add to dashboard Cite

show abstract

“…In LT recipients in particular, the risk of chronic kidney disease in adults is up to 18% by 13 years posttransplant (11). The morbidity and mortality of this complication in pediatric transplant recipients are potentially greater than those described in adults, as children have a longer life span following transplantation with greater cumulative exposure to the calcineurin inhibitors and other nephrotoxic drugs (12)(13)(14). In addition, the impact on kidney function of physiologic changes associated with pubertal growth and development in this population is unknown.…”

Section: Introductionmentioning

confidence: 99%

Glomerular Filtration Rate Following Pediatric Liver Transplantation—The SPLIT Experience

Campbell

Martin

et al. 2010

American Journal of Transplantation

View full text Add to dashboard Cite

Impaired kidney function is a well-recognized complication following liver transplantation (LT). Studies of this complication in children have been limited by small numbers and insensitive outcome measures.Our aim was to define the prevalence of, and identify risk factors for, post-LT kidney dysfunction in a multicenter pediatric cohort using measured glomerular filtration rate (mGFR). We conducted a crosssectional study of 397 patients enrolled in the Studies in Pediatric Liver Transplantation (SPLIT) registry, using mGFR < 90 mL/min/1.73 m 2 as the primary outcome measure. Median age at LT was 2.2 years. Primary diagnoses were biliary atresia (44.6%), fulminant liver failure (9.8%), metabolic liver disease (16.4%), chronic cholestatic liver disease (13.1%), cryptogenic cirrhosis (4.3%) and other (11.8%). At a mean of 5.2 years post-LT, 17.6% of patients had a mGFR < 90 mL/min/1.73 m 2 . In univariate analysis, factors associated with this outcome were transplant center, age at LT, primary diagnosis, calculated GFR (cGFR) at LT and 12 months post-LT, primary immunosuppression, early post-LT kidney complications, age at mGFR, height and weight Z-scores at 12 months post-LT. In multivariate analysis, independent variables associated with a mGFR <90 mL/min/1.73 m 2 were primary immunosuppression, age at LT, cGFR at LT and height Z-score at 12 months post-LT.

show abstract

“…Work in pediatric liver transplantation also recognizes the need to expand outcome assessment beyond patient and graft survival, but also to quality of life years restored, resource utilization, and improved care delivery. Further understanding of these outcomes will help guide future research and care improvement initiatives [84]. …”

Section: C: Pediatric Health Care Quality and Quality Improvement: Lementioning

confidence: 99%

Quality of Health Care in the United States: Implications for Pediatric Inflammatory Bowel Disease

Boyle

Palmér

Kappelman

2009

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

The Institute of Medicine’s publications To Error is Human and Crossing the Quality Chasm publicized the widespread deficits in U.S. health care quality. Emerging studies continue to reveal deficits in the quality of adult and pediatric care, including subspecialty care. In recent years, key stakeholders in the health care system including providers, purchasers, and the public have been applying various quality improvement methods to address these concerns. Lessons learned from these efforts in other pediatric conditions, including asthma, cystic fibrosis, neonatal intensive care, and liver transplantation may be applicable to the care of children with inflammatory bowel disease. This review is intended to be a primer on the quality of care movement in the United States, with a focus on pediatric inflammatory bowel disease. In this article, we review the history, rationale, and methods of quality measurement and improvement, and we discuss the unique challenges in adapting these general strategies to pediatric IBD care.

show abstract

Outcomes After Liver Transplantation

Cited by 29 publications

References 51 publications

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Glomerular Filtration Rate Following Pediatric Liver Transplantation—The SPLIT Experience

Quality of Health Care in the United States: Implications for Pediatric Inflammatory Bowel Disease

Contact Info

Product

Resources

About