Graft Loss After Pediatric Liver Transplantation

Sieders, Egbert; Peeters, Paul; TenVergert, Elisabeth M.; Jong, Koert P. de; Porte, Robert J.; Zwaveling, JH; Bijleveld, Cma; Gouw, Annette; Slooff, Maarten J. H.

doi:10.1097/00000658-200201000-00016

Cited by 57 publications

(49 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Poor long-term outcome has been well documented with the use of organs from very old donors. 7,8 In light of the potential life expectancy in children, long-term outcome is a critical issue and we feel that refusal of these organs was justified. It is difficult to compare these data to other center's experience as this information is rarely published.…”

Section: Discussionmentioning

confidence: 98%

Critical analysis of the pediatric end‐stage liver disease scoring system: A single center experience

et al. 2005

View full text Add to dashboard Cite

The Pediatric End-Stage Liver Disease (PELD) scoring system is a new nationally utilized formula developed to provide a continuous numerical assessment of the risk of death in order to allocate livers to children for transplantation. A retrospective review of the clinical course of children undergoing liver transplantation at the Mount Sinai Medical Center was performed in order to assess the effectiveness of this scoring system in the first 24 months of its utilization. Forty-eight patients underwent liver transplantation with overall patient and graft survival rates of 98% and 96%, respectively. In 23 cases the PELD scoring system determined waiting time for transplantation. Of these 23 patients, 7 moved to the intensive care unit (ICU). Only 2 of 23 patients underwent transplantation with their actual PELD score. The rest required petition for exception (17) or status 1 listing (4). Significant morbidity occurred while awaiting transplantation: failure to thrive (78%), ascites (73%), hemorrhage (49%), infectious complications (39%), encephalopathy (30%), peritonitis (17%), pathologic bone fractures (13%), and hepatopulmonary syndrome (9%). In patients with PELD scores granted by exception the average score that did not yield a liver offer was 38 with an average waiting time of 55 days. At the time of transplantation actual PELD score averaged 22, while the petitioned score was 40. Based upon our center's initial experience, the current PELD scoring system is not adequate. Actual PELD scores did not lead to timely allocation of livers to children. It appears that this scoring system underestimates the nearterm risk of death. Urgent reassessment is required to prevent potential morbidity and mortality in children. In conclusion the United Network for Organ Sharing policy that permits granting of exceptions has circumvented these problems with the PELD scoring system. (Liver Transpl 2005;11:788-795.) O rgan transplantation is a life-saving therapy for many individuals with acute and chronic diseases. The relative success of this therapeutic approach and expanding indications for transplantation coupled with persistent lack of long-term efficacy of other treatments for end-stage organ failure has led to continued relative shortages of organs for transplantation. In light of these shortages, a number of systems have been developed to ration available organs to individuals in need according to ethical, medical, and social criteria. Each system that has been developed strives to optimize organ allocation, with maximal benefit and minimal morbidity and mortality to those who await available organs. Several iterations of allocations systems have evolved. At the outset, each system is designed to be objective and attempts to avoid subject bias. Individual medical centers that participate in these allocation programs are faced with competing demands. One demand from society as a whole is to maintain a "fair" system for all individuals in need of a scarce organ. A competing demand, from individual transplant candidates, ...

show abstract

Section: Discussionmentioning

confidence: 98%

Critical analysis of the pediatric end‐stage liver disease scoring system: A single center experience

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Significant differences in ascites and blood loss were also noted when body weight was taken into consideration. High blood loss index is a risk factor that contributes to poor outcomes of the graft in pediatric LT [19] . The mean blood loss values for G1 and G2 were 28.6 ± 36.7 and 15.0 ± 21.2 mL/kg, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Table 5 shows that the postoperative complications, except for portal vein thrombosis, and the one-and three-year survival rates, were similar between the groups. Portal vein thrombosis is a serious complication of LT, which is associated with high morbidity and mortality in pediatric liver transplantation [19,25,26] . In this study, we experienced 13 cases (12 in G1 and 1 in G2) of perioperative portal vein thrombosis, detected by routine perioperative Doppler ultrasound [4] .…”

Section: G1 (N = 101) G2 (N = 95) P Valuementioning

confidence: 99%

Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

View full text Add to dashboard Cite

AIM:To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation. METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation betweenJune 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients' ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively. RESULTS:The general medical conditions of the G1 Retrospective StudyLiving donor liver transplantation with body-weight more or less than 10 kilograms patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z -scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar. CONCLUSION:Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg. Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.Yang SC, Huang CJ, Chen CL, Wang CH,...

show abstract

“…Primary allograft failure after pediatric liver transplantation (LT) results from entities such as primary nonfunction, vascular complications, biliary complications with ensuing fibrosis/cirrhosis and chronic rejection (1). Except in the settings of extrahepatic sources of sepsis, disseminated malignancies and severe, irreversible neurologic injuries which are absolute contraindications to liver retransplantation (rLT), the approach of most pediatric LT programs is to offer the option of rLT to children with documented allograft failure.…”

Section: Introductionmentioning

confidence: 99%

Liver Retransplantation in Children: A SPLIT Database Analysis of Outcome and Predictive Factors for Survival

Anand

Martz

et al. 2008

American Journal of Transplantation

View full text Add to dashboard Cite

To examine outcomes and identify prognostic factors affecting survival after pediatric liver transplantation, data from 246 children who underwent a second liver transplantation (rLT) between 1996 and 2004 were analyzed from the SPLIT registry, a multi-center database currently comprised of 45 North American pediatric liver transplant programs. The main causes for loss of primary graft necessitating rLT were primary nonfunction, vascular complications, chronic rejection and biliary complications. Three-month, 1-and 2-year patient survival rates were inferior after rLT (74%, 67% and 65%) compared with primary LT (92%, 88% and 85%, respectively). Multivariate analysis of pretransplant variables revealed donor age less than 1 year, use of a technical variant allograft and INR at time of rLT as independent predictive factors for survival after rLT. Survival of patients who underwent early rLT (ErLT, <30 days after LT) was poorer than those who received rLT >30 days after LT (late rLT, LrLT): 3-month, 1-and 2-year patient survival rates 66%, 59%, and 56% versus 80%, 74% and 61%, respectively, log-rank p = 0.0141. Liver retransplantation in children is associated with decreased survival compared with primary LT, particularly, in the clinical settings of those patients requiring ErLT.

show abstract

Graft Loss After Pediatric Liver Transplantation

Cited by 57 publications

References 37 publications

Critical analysis of the pediatric end‐stage liver disease scoring system: A single center experience

Critical analysis of the pediatric end‐stage liver disease scoring system: A single center experience

Living donor liver transplantation with body-weight more or less than 10 kilograms

Liver Retransplantation in Children: A SPLIT Database Analysis of Outcome and Predictive Factors for Survival

Contact Info

Product

Resources

About