Outcomes following liver transplantation in young infants: Data from the SPLIT registry

Abstract

Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre‐, intra‐, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0‐<3, 3‐<6, 6‐<12 months, and 1‐<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5‐10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1‐3.9] and 16.7 [6.8‐29.7] mg/dL) and those <5 kg (2.6 [1.8‐3.4] and 13.5 [3.0‐28.4] mg/dL). A pediatric end ‐stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.

Secondary Malnutrition and Nutritional Intervention in Cholestatic Liver Diseases in Infants

“…Liver transplantation is currently the definitive treatment for most types of liver failure in both children and adults (73)(74)(75)(76). Split grafts, live donations, immunosuppressive regimen upgrades, infectious prophylaxis protocols, and innovative surgical techniques have made it possible to reduce complications and improve survival and quality of life (55)(56)(57)(58)(59)(60)(61)77).…”

Impact of donor age on short-term outcomes after pediatric split liver transplantation

“…Pediatric patients with end-stage liver disease often require pediatric liver transplantation (LT) ( 1 , 2 ). However, donor shortage is an important problem that restricts the widespread use of pediatric LT ( 3 , 4 ).…”

Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting

“…Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting Amy G. Feldman, MD, MSCS, 1 Megan Adams, MD, 2 Adam D. Griesemer, MD, 3 Simon Horslen, MB, ChB, FRCPCH, 4 Beau Kelly, MD, MBA, FACS, FAST, 5 Alisha M. Mavis, MD, 6 George V. Mazariegos, MD, 7 Vicky L. Ng, MD, FRCPC, 8 Emily R. Perito, MD, MAS, 9 Manuel I. Rodriguez-Davalos, MD, FACS, 10 James E. Squires, MD, MS, 4 Greg Tiao, MD, 11 George S. Yanni, MD, FAASLD, 12 and Evelyn K. Hsu, MD 13 T he Society of Pediatric Liver Transplantation (SPLIT) has grown into a community of over 40 centers with synergistic platforms in research, education, advocacy, quality improvement, and clinical care. In 2019, SPLIT joined forces with the Transplantation Society in a mission to improve the lives of children who require (and undergo) liver transplantation (LT).…”