Predictors of early graft survival after pediatric liver transplantation

Abstract

The objective of this study was to identify peritransplant predictors of early graft survival and posttransplant parameters that could be used to predict early graft outcomes after pediatric liver transplantation (PLT). The response of children to liver dysfunction after liver transplantation (LT) is poor. No data have been reported for early predictors of poor graft survival, which would potentially be valuable for rescuing children at risk after LT. A retrospective cohort study of 422 PLT procedures performed from 2000 to 2010 at a single center was conducted. Multiple peritransplant variables were analyzed. Univariate and multivariate analyses using receiver operating characteristic curves were performed to identify predictors of early graft loss (ie, at 30, 60, and 90 days). The number needed to treat (NNT) was calculated when the risk factors were identified. Comparisons with the Olthoff criteria for early graft dysfunction in adults were performed. The overall 30-, 60-, and 90-day graft survival rates were 93.6%, 92.6%, and 90.7%, respectively. A recipient age of 0 to 2 or 6 to 16 years, acute liver failure, and a posttransplant day 7 serum bilirubin level > 200 lmol/L were risk factors for graft loss in the 3-strata Cox models. The product of the peak aspartate aminotransferase (AST) level, day 2 international normalized ratio (INR) value, and day 7 bilirubin level [with 30-, 60-, and 90-day areas under the receiver operating characteristic curve (AUROCs) of 0.774, 0.752, and 0.715, respectively] and a day 7 bilirubin level > 200 lmol/ L (with 30-, 60-, and 90-day AUROCs of 0.754, 0.661, and 0.635, respectively) provided excellent prediction rates for early graft loss (30-days for Day-7-bilirubin level > 200) in the pediatric population (sensitivity = 72.7%, specificity = 96.6%, positive predictive value = 95.5%, negative predictive value = 78%). The NNT with early retransplantation when the day 7 bilirubin level was >200 lmol/L was 2.17 (unadjusted) or 2.76 (adjusted for graft survival). In conclusion, 2 scores-the product of the peak AST level, day 2 INR value, and day 7 bilirubin level and a posttransplant day 7 bilirubin level > 200 lmol/L-have been identified as clinically valuable tools with high accuracy for predicting early graft loss. A more aggressive attitude to considering early retransplantation in this group may further improve survival after LT.

Relevance of Postoperative Peak Transaminase After Elective Hepatectomy

“…This is not unprecedented as it has been recently reported that postoperative model for end-stage liver disease score was better than PST-based models to predict early posttransplant mortality. 24 In addition, whereas high PST values were associated with lower early graft and patient survival in several studies, [25][26][27][28] this result remains controversial. 25 PST had a limited influence of LOS.…”

Magnetic Cell Labeling of Primary and Stem Cell-Derived Pig Hepatocytes for MRI-Based Cell Tracking of Hepatocyte Transplantation

“…Liver cell transplantation in humans has proved to be feasible and safe, and the majority of the cases demonstrated clinical improvements over time. However, it has not yet achieved sustainable benefits for patients due to the poor repopulating capacity of engrafted cells [ 11 , 47 , 48 ]. Possible reasons for the unsustainable long-term outcome of transplanted cells may be insufficient cell translocation through the endothelial cell barrier, insufficient cell engraftment into the liver plates and destruction of the engrafted cells by the immune system.…”

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

“…The Olthoff criteria used for the definition of EAD have been shown to adequately predict graft survival in pediatric liver transplant recipients [33]. Indeed, in our population, 3-month graft survival was 24% lower if EAD occurred.…”