Posttransplant survival in pediatric fulminant hepatic failure: The SPLIT experience

Baliga, Prabhakar K.; Alvarez, S.; Lindblad, Anne S.; Zeng, Liyun

doi:10.1002/lt.20252

Cited by 99 publications

(102 citation statements)

References 37 publications

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“…Conversely, deterioration of mental status results in patients requiring mechanical ventilation and intensive support during hospitalization. 8 In our study, the length of stay in the intensive care unit preoperatively for groups FHF and ESLD were 3.14 ± 4.00 vs 1.47 ± 3.83 day (P = .003). Compared with patients in group FHF, those in group ESLD were more frequently extubated in the operating room (31.8% vs 89.5% P < .001).…”

Section: Discussionmentioning

confidence: 51%

Untitled

2014

Exp Clin Transplant

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Objectives: We assessed the anesthetic management and short-term morbidity and mortality in pediatrics patients who underwent an orthotopic liver transplant for fulminant hepatic failure or end-stage liver disease in a university hospital. Material and Methods: We retrospectively analyzed the records of children who underwent orthotopic liver transplant from May 2002 to May 2012. Patients were categorized into 2 groups: group fulminant hepatic failure (n=22) and group end-stage liver disease (n=19). Perioperative data related to anesthetic management and intraoperative events were collected along with information related to postoperative course and survival to hospital discharge. Results: Mean age and weight for groups fulminant hepatic failure and end-stage liver disease were 8.6 ± 2.7 years and 10.8 ± 3.8 years (P = .04) and 29.2 ± 11.9 kg and 33.7 ± 16.9 kg (P = .46). There were no differences between the groups regarding length of anhepatic phase (65 ± 21 min vs 73 ± 18 min, P = .13) and operation time (9.1 ± 1.6 h vs 9.5 ± 1.8 h, P = .23). When compared with the patients in group fulminant hepatic failure, those in group end-stage liver disease more commonly had a Glasgow Coma score of 7 or less (32% vs 6%, P = .04). Compared with patients in group fulminant hepatic failure, those in group end-stage liver disease were more frequently extubated in the operating room (31.8% versus 89.5% P < .001). Postoperative duration of mechanical ventilation (2.78 ± 4.02 d vs 2.85 ± 10.21 d, P = .05), and the mortality rates at 1 year after orthotopic liver transplant (7.3% vs 0%, P = .09) were similar between the groups. Conclusions: During pediatric orthotopic liver transplant, those children with fulminant hepatic failure require more intraoperative fluids and more frequent perioperative mechanical ventilation than those with end-stage liver disease.

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Section: Discussionmentioning

confidence: 51%

Untitled

2014

Exp Clin Transplant

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“…[3,4] Decisions are made on the basis of readily available data, including the clinical condition, presence of encephalopathy and cerebral oedema, diagnosis, age of patient, duration of illness, level of jaundice and various measures of coagulation, and possibly ammonia, fetoprotein, lactate and plasma phosphate levels. Strict cutoff levels that precisely predict death or survival do not exist.…”

Section: Indications For Liver Transplantation In a Child With Alfmentioning

confidence: 99%

“…[3] Over a 3year period, from 2009 to 2011, there were 241 (14.4%) liver transplants in children listed at status 1A in the USA; this number also includes those who required emergency retransplantation for hepatic artery thrombosis and primary nonfunction. [7] Outcomes of liver transplantation for ALF have generally shown poorer survival than for chronic liver failure.…”

Section: Outcomes Of Alf In Childhoodmentioning

confidence: 99%

“…In the early SPLIT experience from 1995 to 2002, there was a 74% 1year patient survival rate for ALF compared with 88.2% for all other causes. [3] Farmer et al [8] summarised the published literature and described 1year posttransplant survival in children with ALF as ranging from 67% to 93%. On the basis of a multivariate analysis of data from the University of California, Los Angeles, these authors also suggested that predictors of patient survival after liver transplantation in children with ALF were: better renal function (calculated creatinine clearance >60 mL/min/1.73 m 2 ); and a duration of jaundice to encephalopathy of >7 days.…”

Section: Outcomes Of Alf In Childhoodmentioning

confidence: 99%

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Acute liver failure and transplantation in children

Horslen

2014

S Afr Med J

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“…Early survival rates are worse for patients who have acute liver failure [9,202,203] and liver tumors [11] , but their long-term survival rates are similar to those of other recipients. Asso- Spada M et al .…”

Section: Diagnosismentioning

confidence: 99%

268 Pediatric Liver Transplantation

Podestá

Rosenthal²,

Sher³

et al.

SpringerReference

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In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of improvements in medical, surgical and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, have had a significant impact on graft and patient survival. Future developments of pediatric liver transplantation will deal with long-term followup, with prevention of immunosuppression-related complications and promotion of as normal growth as possible. This review describes the state-of-the-art in pediatric liver transplantation.

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Posttransplant survival in pediatric fulminant hepatic failure: The SPLIT experience

Cited by 99 publications

References 37 publications

Untitled

Untitled

Acute liver failure and transplantation in children

268 Pediatric Liver Transplantation

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