Pediatric Liver Transplantation: 10 Years Eurotransplant Experience.

Wiesenhaan-Stellingwerff, G. C.; Smits, Jacqueline M.; Boer, Jan de; Gg, Persijn; Mj, Slooff

doi:10.1097/00007890-200004271-00388

Cited by 5 publications

(8 citation statements)

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“…Overall, the patient and graft survival rates are comparable with those previously published and similar factors affecting outcome are observed (3–8). As expected, these data confirm that children transplanted in a more precarious state of health tends to have worse outcomes.…”

Section: Discussionsupporting

confidence: 86%

“…In most published pediatric series the principal complications associated with graft loss are vascular complications, especially HAT, biliary complications, primary non‐function and acute and chronic rejection (2–8). The analysis of the SPLIT database confirms rates of HAT (8.3% overall, 4% requiring re‐transplant) and biliary complications (14%) similar to those previously published (2–8). However, graft loss in the SPLIT registry from acute rejection (3.3%) or from chronic rejection (5.7%) is somewhat lower, possibly relating to the increased use of tacrolimus since 1995 when the database was initiated.…”

Section: Discussionmentioning

confidence: 99%

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Studies of Pediatric Liver Transplantation 2002: Patient and graft survival and rejection in pediatric recipients of a first liver transplant in the United States and Canada

Martin

Atkison

Anand

et al. 2004

Pediatric Transplantation

156

134

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Studies of Pediatric Liver Transplantation (SPLIT) is a cooperative research network comprising 38 pediatric liver transplant centers in North America. Data from the 1092 patients who have received a first liver transplant since 1995 were analyzed for factors influencing patient survival, graft survival and acute rejection. The 3, 12, 24 and 36 month Kaplan-Meier estimates of patient/graft survival were 90.9/85.5, 86.3/80.2, 84.3/76.0, and 83.8/75.3% respectively. Univariate analysis identified initial diagnosis, type of graft (whole vs. living and cadaveric technical variant), growth failure and continuous hospitalization or ICU admission prior to transplantation as significantly influencing patient and graft survival. Subsequent multivariate analysis identified as risk factors for death: fulminant liver failure (RR = 3.05, p < 0.05), cadaveric technical variant grafts (RR = 1.95, p < 0.05), continuous hospitalization pre-transplant (RR = 1.79, p < 0.05), height deficit >2 s.d. from mean (RR = 3.22, p < 0.05). Risk factors for graft loss included: fulminant liver failure (RR = 2.27, p < 0.05), cadaveric technical variant grafts, (RR = 1.97, p < 0.05). Eleven percent of the 1092 patients were re-transplanted; vascular complications, particularly hepatic artery thrombosis (8.3% overall; 36.3% of graft failures), were responsible for the majority of re-transplants. Infection was the single most important cause of death (40 of 141, 28.4%) and was a contributing cause in 55 (39%), particularly with bacterial or fungal organisms. The cumulative Kaplan-Meier estimates of first rejection at 3, 12, 24 and 36 months were 44.8, 52.9, 59.1, and 60.3%. Initial immunosuppression with tacrolimus reduced the probability of rejection (RR = 0.62, p < 0.05). Eleven percent of rejections were steroid-resistant; chronic rejection led to 7 of 121 (5.8%) re-transplants. The SPLIT registry, in compiling data from a large number of centers, reflects the current outcomes for pediatric liver transplants in North America.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Studies of Pediatric Liver Transplantation 2002: Patient and graft survival and rejection in pediatric recipients of a first liver transplant in the United States and Canada

Martin

Atkison

Anand

et al. 2004

Pediatric Transplantation

156

134

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“…The 2-year patient and graft survival for recipients of a first liver transplant of 82% and 72%, respectively, are consistent with analyses of other pediatric liver transplant databases (1,23). Single centers report even higher success rates, and in particular, show no survival disadvantage for children less than 1 year (24) or recipients of partial liver grafts (25).…”

Section: Split Research Groupsupporting

confidence: 80%

“…The early autonomic storm resulting from cerebral ischemia and herniation of the brain stem is associated with a massive release of endogenous catecholamines and is subsequently followed by a hypotensive period with a reduced sympathetic outflow (21)(22)(23). Supplementation of catecholamines may therefore contribute to hemodynamic stability during this phase, as brain death is noted to be accompanied by a decrement in hormone release, including thyroid and adrenal stimulating hormones, because of the interruption of the mid-brain pituitary-based hormone axis.…”

Section: Discussionmentioning

confidence: 99%

Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation1

et al. 2001

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“…In examining our overall experience since 1984, univariate graft survival analysis indicates that segmental LTx from deceased donors had inferior outcomes for infant recipients. OPTN/SRTR and European transplant registry analyses confirm these findings (44–46). However, when the most recent decade is analyzed, graft type no longer plays a role in infant graft survival (Log-Rank Test, p=0.34).…”

Section: Discussionsupporting

confidence: 56%

Predictors of Survival Following Liver Transplantation in Infants: A Single-Center Analysis of More Than 200 Cases

Venick

Farmer²,

McDiarmid

et al. 2010

Transplantation

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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 vs. older children, and identify pre-transplant factors which influence survival. Over 25 pre-LTx demographic, laboratory, and operative variables were analyzed using the Log-Rank Test and Cox Proportional Hazards Model. Results Between 1984–2006 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%), while leading causes of death were sepsis and multi-organ failure. 1,5 and 10 year graft and patient survival were 75/72/68 and 79/77/75%. Relative to older pediatric recipients infants had worse overall patient survival (p=0.05). The following were significant univariate predictors of graft loss: age < 6 months, and reduced cadaveric grafts; and of patient loss: age < 6 months, calculated CrCl <90, pre-LTx hospitalization, pre-LTx mechanical ventilation, repeat LTx, infants transplanted for reasons other than cholestatic liver disease, and patients transplanted between 1984–1994. 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 which can aid in medical decision making.

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Pediatric Liver Transplantation: 10 Years Eurotransplant Experience.

Cited by 5 publications

References 0 publications

Studies of Pediatric Liver Transplantation 2002: Patient and graft survival and rejection in pediatric recipients of a first liver transplant in the United States and Canada

Studies of Pediatric Liver Transplantation 2002: Patient and graft survival and rejection in pediatric recipients of a first liver transplant in the United States and Canada

Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation1

Predictors of Survival Following Liver Transplantation in Infants: A Single-Center Analysis of More Than 200 Cases

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