Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases. Transplantation 2010 Mar 15;89(5):600-5
Date
12/10/2009Pubmed ID
19997060Pubmed Central ID
PMC2836423DOI
10.1097/TP.0b013e3181c5cdc1Scopus ID
2-s2.0-77949367823 (requires institutional sign-in at Scopus site) 50 CitationsAbstract
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 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.
RESULTS: 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% and 79%/77%/75%, respectively. Relative to older pediatric recipients, infants had worse overall patient survival (P=0.05). The following were significant univariate predictors of graft loss: age less than 6 months and reduced cadaveric grafts; and of patient loss: age less than 6 months, calculated CrCl less than 90, pre-LTx hospitalization, pre-LTx mechanical ventilation, repeat LTx, infants transplanted for reasons other than cholestatic liver disease, and patients transplanted between 1984 and 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 that can aid in medical decision making.
Author List
Venick RS, Farmer DG, McDiarmid SV, Duffy JP, Gordon SA, Yersiz H, Hong JC, Vargas JH, Ament ME, Busuttil RWMESH terms used to index this publication - Major topics in bold
Body SizeCholestasis
Cohort Studies
Creatinine
Decision Making
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Survival
Humans
Infant
Liver Failure
Liver Transplantation
Male
Predictive Value of Tests
Renal Replacement Therapy
Retrospective Studies
Survival Rate
Time Factors