Predicting early outcomes of liver transplantation in young children: The EARLY study (original) (raw)
Related papers
Annals of Surgery, 2011
The purpose of this study was to identify significant, independent factors that predicted 6 month patient and graft survival after pediatric liver transplantation. Summary Background Data: The Studies of Pediatric Liver Transplantation (SPLIT) is a multicenter database established in 1995, of currently more than 4000 US and Canadian children undergoing liver transplantation. Previous published analyses from this data have examined specific factors influencing outcome. This study analyzes a comprehensive range of factors that may influence outcome from the time of listing through the peri-and postoperative period. Methods: A total of 42 pre-, peri-and posttransplant variables evaluated in 2982 pediatric recipients of a first liver transplant registered in SPLIT significant at the univariate level were included in multivariate models. Results: In the final model combining all baseline and posttransplant events, posttransplant complications had the highest relative risk of death or graft loss. Reoperation for any cause increased the risk for both patient and graft loss by 11 fold and reoperation exclusive of specific complications by 4 fold. Vascular thromboses, bowel perforation, septicemia, and retransplantation, each independently increased the risk of patient and graft loss by 3 to 4 fold. The only baseline factor with a similarly high relative risk for patient and graft loss was recipient in the intensive care unit (ICU) intubated at transplant. A significant center effect was also found but did not change the impact of the highly significant factors already identified. Conclusions: We conclude that the most significant factors predicting patient and graft loss at 6 months in children listed for transplant are posttransplant surgical complications.
Liver Transplantation, 2006
The current United Network for Organ Sharing (UNOS) policy is to allocate liver grafts to pediatric patients with chronic liver disease based on the pediatric end-stage liver disease (PELD) scoring system, while children with fulminant hepatic failure may be urgently listed as Status 1a. The objective of this study was to identify pre-transplant variables that influence patient and graft survival in those children undergoing LTx (liver transplantion) for FHF (fulminant hepatic failure) compared to those patients transplanted for extrahepatic biliary atresia (EHBA), a chronic form of liver disease. The UNOS Liver Transplant Registry was examined for pediatric liver transplants performed for FHF and EHBA from 1987 to 2002. Variables that influenced patient and graft survival were assessed using univariate and multivariate analysis. Kaplan-Meier analysis of FHF and EHBA groups revealed that 5 year patient and graft survival were both significantly worse (P Ͻ 0.0001) in those patients who underwent transplantation for FHF. Multivariate analysis of 29 variables subsequently revealed distinct sets of factors that influenced patient and graft survival for both FHF and EHBA. These results confirm that separate prioritizing systems for LTx are needed for children with chronic liver disease and FHF; additionally, our findings illustrate that there are unique sets of variables which predict survival following LTx for these two groups.
Analysis of risk factors following pediatric liver transplantation
Transplant International, 2000
Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses . In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36 % were under 2 years of age. Indications for LT were cholestatic disease in 68 (56 %), metabolic diseases in 18 (14 %), fulminant hepatic failure in 8 (7.5 %), cirrhosis in 7 (5.8 %), and retransplants in 17 (14 %). Whole liver was transplanted in 79 % of cases and partial liver in 21 %. Actuarial survival at 1, 5, and 10 years was 70 %, 61 %, and 57 %, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.
Transplantation, 2010
Infants (<12 months) who require liver transplantation (LTx) represent a particularly challenging and understudied group of patients. This retrospective study aimed to describe a large single-center experience of infants who received isolated LTx, illustrate important differences in infants versus older children, and identify pretransplant factors which influence survival. More than 25 pre-LTx demographic, laboratory, and operative variables were analyzed using the Log-rank test and Cox proportional hazards model. Between 1984 and 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%), whereas leading causes of death were sepsis and multiorgan failure. One-, 5-, and 10-year graft and patient survivals were 75%/72%/68% an...
The Journal of Pediatrics, 2012
for the Studies of Pediatric Liver Transplantation (SPLIT) Research Group* Objectives To determine clinical and health-related quality of life outcomes, and to derive an ''ideal'' composite profile of children alive 10 years after pediatric liver transplantation (LT) performed in the US and Canada. Study design This was a multicenter cross-sectional analysis characterizing patients enrolled in the Studies of Pediatric Liver Transplantation database registry who have survived >10 years from LT. Results A total of 167 10-year survivors were identified, all of whom received daily immunosuppression therapy. Comorbidities associated with the post-LT course included post-transplantation lymphoproliferative disease (in 5% of patients), renal dysfunction (9%), and impaired linear growth (23%). Health-related quality of life, as assessed by the PedsQL 4.0 Generic Core Scales, revealed lower patient self-reported total scale scores for 10-year survivors compared with matched healthy children (77.2 AE 12.9 vs 84.9 AE 11.7; P < .001). At 10 years post-LT, only 32% of patients achieved an ideal profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression-induced sequelae. Conclusion Success after pediatric LT has moved beyond patient survival. Availability of an ideal composite profile at follow-up provides opportunities for patients, families, and healthcare providers to identify broader sets of outcomes at earlier stages, ultimately contributing to improved outcomes after pediatric LT. (J Pediatr 2012;160:820-6). L iver transplantation (LT) is a well-established treatment for children with end-stage liver disease caused by biliary atresia, fulminant liver failure, metabolic liver conditions, hepatic tumors, and other rare cholestatic liver diseases. 1,2 The reported 5-year patient survival rate after pediatric LT performed in North America is >85%. 3 Although a recent study reported an overall life expectancy of 22.2 years for adult LT recipients, the true ceiling for patient survival and allograft longevity in children who have undergone LT remains unknown and is likely higher. 4,5 Thus, the focus of post-LT care in children has shifted to encompass consequences related to the post-transplant course. Current knowledge dictating lifelong treatment with immunosuppressive medications has particular impact for pediatric patients, given that many children will live long enough to potentially develop end-organ damage. 5-7 Comprehensive descriptions of health status and analysis of factors that induce illness in the long-term follow-up of pediatric LT recipients are lacking. Consequently, the primary objective of this study was to address this gap in the literature by characterizing clinical outcomes, health status, and health-related quality of life (HRQOL) in children registered in a multicenter North American database registry, the Studies of Pediatric Liver Transplantation (SPLIT), who achieved 10-year survival. The secondary objective was to characterize the ''ideal'' longterm survivor of pediatric LT and to provide clinically relevant information to healthcare practitioners caring for recipients of LT performed in childhood.
Long term outcomes of pediatric liver transplantation according to age
Journal of Korean medical science, 2014
Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). T...
Scoring Systems and Postoperative Outcomes in Pediatric Liver Transplantation
Transplantation Proceedings, 2019
Purpose. The aim of this study is to investigate the effects of risk scores (Pediatric Endstage Liver Disease [PELD], Child-Turcotte-Pugh [CTP], and Pediatric Risk of Mortality [PRISM-III]) of pediatric liver transplant patients on the postoperative period. Method. Seven cadaveric and 45 living donors, totaling 52 pediatric liver transplantation (LT) patients, were reviewed retrospectively. PELD and CTP scores were calculated based on data at hospital admission. PRISM-III score was calculated from data during the first 24 hours of intensive care unit (ICU) admission. Hospital length of stay (LOS), ICU LOS, patients who developed acute kidney injury (AKI), requirement for inotropicvasopressor therapy, hospital mortality, long-term mortality, duration of mechanical ventilation, metabolic disease, and demographic features were documented.For CTP score, class C was defined as high, and A and B as low. Cutoff values of PELD and PRISM-III scores were detected by using receiver operating characteristic curves. According to these cutoff values, patients were divided into 2 groups as high and low for each score. Documented data was analyzed and compared in groups for each score. Results. Hospital LOS was significantly longer in the high-PELD (P ¼ .01) and high-CTP (P ¼ .01) groups. ICU LOS was significantly longer in the high-PRISM-III group (P ¼ .01). Requirement for inotropic-vasopressor therapy was significantly higher in the high-PELD (P ¼ .04) and high-CTP (P ¼ .04) groups. Conclusion. Hemodynamic instability and long hospital LOS can be expected in pediatric post-LT patients with high PELD or CTP scores; there is also the risk that AKI maybe higher for high-PELD score patients. Unexpectedly, the PRISM-III score did not have any correlation with the severity of physiological condition and mortality. L IVER transplantation (LT) is the definitive treatment for end-stage liver disease in pediatric patients [1]. The intensive care unit (ICU) plays a vital role in liver transplant. Several scoring systems have been used to quantify the severity of illness and to predict survival and poor outcomes in ICU patients. But a reliable method for identifying pediatric patients at risk for poor outcomes following LT is lacking. This study examined a general physiology-based system and 2 disease severity systems to determine their usefulness in predicting outcomes in pediatric LT patients. Pediatric End-stage Liver Disease (PELD) score was proposed as a disease severity scale for pediatric liver
Prognostic factors for lethal outcome in early postoperative pediatric liver transplantation
PROCEEDINGS OF THE 45TH INTERNATIONAL CONFERENCE ON APPLICATION OF MATHEMATICS IN ENGINEERING AND ECONOMICS (AMEE’19)
Liver transplantation (LT) is a curative treatment for end-stage liver disease in the childhood. Pediatric LT is one of the most up-to-date and fast-growing areas in contemporary medicine. The main goal in this area is to create predictive models for an onset of complications that would increase survival rate. Infectious complications are the leading cause of morbidity and mortality in all periods after LT. In the present work, using a univariate and bivariate logistic regression analysis estimates of the probabilities of death in the early postoperative period after LT are derived. As predictors for mortality in the constructed logistic models the following parameters have been analyzed: blood plasma levels at 1 st , 2 nd , 3 rd , 5 th , 7 th and 10 th postoperative day of bilirubin, sodium, creatinine, international normalized ratio (INR) of prothrombin time of blood coagulation and model coefficient for end-stage liver disease (MELD). The models were based on experimental data obtained in
Turkish Journal of Pediatrics, 2023
Liver transplantation (LT) is the standard of treatment with excellent outcomes for many end-stage pediatric liver disorders. It can provide a long and healthy life, especially for pediatric patients following recovery from the early period. The classical indication for LT is liver failure causing a life-threatening situation resulting in a mortality risk higher than 90% at one year. End-stage liver disease (ESLD) from biliary atresia remains the most common cause of liver disease leading to transplantation. Progressive familial intrahepatic cholestasis (PFIC), metabolic diseases, fulminant liver failure, and cryptogenic cirrhosis are the other causes of end-stage liver disease leading to LT. 1,2
100 Consecutive liver transplants in infants and children: An 8-year experience
Journal of Pediatric Surgery, 1994
Madison, Wisconsin 0 Orthotopic liver transplantation has become the treatment of choice for most children and infants with end-stage liver disease. The purpose of this retrospective study was to examine the results of 100 consecutive liver transplants performed in infants and children at a single institution. During an 8-year study period (July 1984 to December 1992), 100 pediatric liver transplants were performed in 78 patients. Thirty-four patients (44.7%) were infants (mean age, 7.0 months; mean weight, 8.1 kg), and 42 (55.3%) were children (mean age, 8.2 years; mean weight, 30.8 kg). There were 38 reduced-size liver transplants (RLT) and 54 whole-size transplants (WLT). Eight infants (23.5%) and 10 children (20.7%) required retransplantation. After transplantation, 71% of the patients had one or more rejection episodes, 88% had one or more infections, 17.1% had biliary complications, and 39.4% required one or more reoperations. There were 17 deaths.