Predictors of clinical outcome in children undergoing orthotopic liver transplantation for acute and chronic liver disease

Abstract

The current United Network for Organ Sharing (UNOS) policy is to allocate liver grafts to pediatric patients with chronic liver disease based on the pediatric end-stage liver disease (PELD) scoring system, while children with fulminant hepatic failure may be urgently listed as Status 1a. The objective of this study was to identify pre-transplant variables that influence patient and graft survival in those children undergoing LTx (liver transplantion) for FHF (fulminant hepatic failure) compared to those patients transplanted for extrahepatic biliary atresia (EHBA), a chronic form of liver disease. The UNOS Liver Transplant Registry was examined for pediatric liver transplants performed for FHF and EHBA from 1987 to 2002. Variables that influenced patient and graft survival were assessed using univariate and multivariate analysis. Kaplan-Meier analysis of FHF and EHBA groups revealed that 5 year patient and graft survival were both significantly worse (P Ͻ 0.0001) in those patients who underwent transplantation for FHF. Multivariate analysis of 29 variables subsequently revealed distinct sets of factors that influenced patient and graft survival for both FHF and EHBA. These results confirm that separate prioritizing systems for LTx are needed for children with chronic liver disease and FHF; additionally, our findings illustrate that there are unique sets of variables which predict survival following LTx for these two groups.

A Multivariate Analysis of Pre-, Peri-, and Post-Transplant Factors Affecting Outcome After Pediatric Liver Transplantation

“…This risk of death or graft loss increased substantially to 3.7 and 2.1 if the patient was also intubated, a finding substantiated by others. 2,23,24 The individual components of the PELD score were not predictive of outcome at 6 months, either in the multivariate analysis of only base line factors (with the exception of growth failure for patient survival) or in the multivariate models, including baseline and posttransplant complications. Although other studies have sought to find a relationship between PELD and posttransplant outcome, 19,25 in this large cohort of patient, it is not surprising that the PELD score, which was developed only as a predictor or waiting list mortality, 26 would not be significant predictor of posttransplant outcome in an analysis that includes posttransplant events.…”

Evaluation of the Liver Injury Unit Scoring System to Predict Survival in a Multinational Study of Pediatric Acute Liver Failure

“…Although components of the MELD were thought to be a predictive factor in ALF (INR and bilirubin), the MELD score itself had poor specificity. 14 Rhee et al 15 eloquently showed that separate prioritizing systems for LT are needed in children with chronic liver disease and with PALF.…”

Immunophenotype Predicts Outcome in Pediatric Acute Liver Failure

“…Diagnostic categories for PALF based on previously defined criteria 1 included (1) acetaminophen associated ALF (2) autoimmune ALF (3) drug-induced ALF (4) ALF due to viral hepatitis (5) metabolic disease including Wilsons disease, mitochondrial disease, or disorders of fat metabolism diagnosis (6) other or (7) indeterminate ALF.…”