Predictors of Survival Following Liver Transplantation in Infants: A Single-Center Analysis of More Than 200 Cases

Abstract

Background Infants (<12 months) who require liver transplantation (LTx) represent a particularly challenging and understudied group of patients. Methods This retrospective study aimed to describe a large single center experience of infants who received isolated LTx, illustrate important differences in infants vs. older children, and identify pre-transplant factors which influence survival. Over 25 pre-LTx demographic, laboratory, and operative variables were analyzed using the Log-Rank Test and Cox Proportional Hazards Model. Results Between 1984–2006 216 LTx were performed in 186 infants with a mean follow-up time of 62 months. Median age at LTx was 9 months, the majority had cholestatic liver disease, were hospitalized pre-LTx, and received whole grafts. Leading indications for re-LTx (n=30) included vascular complications (43%) and graft nonfunction (40%), while leading causes of death were sepsis and multi-organ failure. 1,5 and 10 year graft and patient survival were 75/72/68 and 79/77/75%. Relative to older pediatric recipients infants had worse overall patient survival (p=0.05). The following were significant univariate predictors of graft loss: age < 6 months, and reduced cadaveric grafts; and of patient loss: age < 6 months, calculated CrCl <90, pre-LTx hospitalization, pre-LTx mechanical ventilation, repeat LTx, infants transplanted for reasons other than cholestatic liver disease, and patients transplanted between 1984–1994. Conclusions Long-term outcomes for infants undergoing LTx are excellent and have improved over time. As the largest, single center analysis of LTx in infants this study elucidates a unique set of predictors which can aid in medical decision making.

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

“…( 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).…”

Long Term Outcomes of Pediatric Liver Transplantation According to Age

“…Recently, Venick et al (17) reported that the 1, 5, and 10 yr graft survival rates under 12 months of age were 75%, 72%, and the patient survival rates 68% and 79%, 77%, and 75%, respectively. Their report concluded that, compared to older recipients, small infants showed poorer survival outcome.…”

Long-term Clinical Relevance of De Novo Donor-Specific Antibodies After Pediatric Liver Transplantation

“…I mprovements in surgical techniques and perioperative care as well as optimization of immunosuppressive medications have led to excellent rates of patient and graft survivals after pediatric liver transplantation (LT), almost independent of the recipient's age. 1,2 It is now important to focus on improving long-term outcomes for pediatric transplant recipients. The immune mechanisms that lead to chronic allograft dysfunction are still not clearly defined, but there is increasing evidence that mismatching of anti-HLA antibodies and the presence of anti-donor specific antibodies (DSA) may adversely impact long-term graft survival.…”