Living Donor Liver Transplantation in Children: Perioperative Risk Factors and a Nomogram for Prediction of Survival

Abstract

Background. Living donor liver transplantation (LDLT) in children has achieved promising outcomes during the past few decades. However, it still poses various challenges. This study aimed to analyze perioperative risk factors for postoperative death in pediatric LDLT. Methods. We retrospectively analyzed medical records of pediatric patients who underwent LDLT surgery from January 1, 2014, to December 31, 2016, in our hospital. Predictors of mortality following LDLT were analyzed in 430 children. Cox regression and Kaplan–Meier curve analysis were used for covariates selection. A nomogram was developed to estimate overall survival probability. The performance of the nomogram was assessed using calibration curve, decision curve analysis, and time-dependent receiver operating characteristic curve. Results. Among the 430 patients in this cohort (median [interquartile range] age, 7 [6.10] mo; 189 [43.9%] female; 391 [90.9%] biliary atresia), the overall survival was 91.4% (95% confidence interval, 89.2-94.4), and most of the death events (36/37) happened within 6 months after the surgery. Multivariate analysis indicated that the Pediatric End-stage Liver Disease score, neutrophil lymphocyte ratio, graft-to-recipient weight ratio, and intraoperative norepinephrine infusion were independent prognostic factors. A novel nomogram was developed based on these prognostic factors. The C index for the final model was 0.764 (95% confidence interval, 0.701-0.819). Decision curve analysis and time-dependent receiver operating characteristic curve suggested that this novel nomogram performed well at predicting mortality of pediatric LDLT. Conclusions. We identified several perioperative risk factors for mortality of pediatric LDLT. And the newly developed nomogram can be a convenient individualized tool in estimating the prognosis of pediatric LDLT.

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation

“…In our study, a cut-off point of more than 3 mmol/L in the immediate post-operative period (first hour after admission to the PICU) was related to biliary complications, vascular thrombosis and death. In adult patients, Jipa et al found a similar cut-off point to what was found in our study (>3 mmol/L), which was correlated with intraoperative blood loss when evaluated in the immediate post-operative period ( 27 , 28 ).…”

Pediatric living donor liver transplantation (LDLT): Short- and long-term outcomes during sixteen years period at a single centre- A retrospective cohort study

“…Higher PELD/MELD scores had a trend towards significant correlation with poor patient survival in our work, also, a higher PELD score was an independent predictor of poor patient survival in Pan et al, 2020 [ 22 ], Lu, et al, 2020 [ 25 ] and Kehar et al, 2019 [ 32 ] studies , moreover, it was a significant predictor of patient loss in Oh et al, 2010 [ 42 ]; study, in contrast, it did not affect survival in Kitajima et al, 2017 [ 2 ], Raices, et al, 2019 [ 8 ], Chung, et al, 2020 [ 48 ] or Shehata et al, 2012 [ 58 ] studies.…”

“…They should be prevented, and if occurred; should be diagnosed and managed early to improve graft and patient outcomes, however, those outcomes are affected also by additional variables (i.e. Large for size graft (LFSG), pediatric end-stage liver disease (PELD)/model for end-stage liver disease (MELD) scores, centre experience/volume, operative time, operative blood loss, blood transfusion units, etc); those variables should be modulated also for getting better short-and long-term outcomes [ 8 , [22] , [23] , [24] , [25] , [26] ] .…”

Technical Choices in Pediatric Living Donor Liver Transplantation: The Path to Reduce Vascular Complications and Improve Survival

“…In a similar study from Kyoto, Ueda et al ( 17 ) reported the results in 568 primary LDLTs and showed that the factors independently associated with worse patient survival were fulminant liver failure, GRWR <0.8%, and ABO incompatibility, but the analysis was not limited to 90‐day survival. A recent study from Lu et al ( 18 ) on 430 primary PLDLTs found that PELD score, neutrophil lymphocyte ratio, GRWR (>4%), and intraoperative use of norepinephrine were independent prognostic factors related to 180‐day patient survival. In this article, the majority of the recipient’s deaths occurred within 6 months after transplant (36/37), but the follow‐up time in the series was relatively short.…”