Prognostic Factors in Pediatric Early Liver Retransplantation

Reyes, Isabel Cañon; Halac, Esteban; Aredes, Diego; Lauferman, Leandro; Cervio, Guillermo; Dip, Marcelo; Minetto, Julia; Reijenstein, Hayellen; Meza, V. Duarte; Gole, Maria; Dillon, Agustina Jacobo; Imventarza, Oscar

doi:10.1002/lt.25719

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…The decreased incidence of re-transplantation in LD recipients either <10 years old or <10 kg is an interesting finding in our study. Prognostic factors and indications for pediatric re-transplantation have been elucidated, but the association with the type of graft has not been studied to our knowledge ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Dalzell¹,

Vargas²,

Soltys³

et al. 2022

Transpl Int

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Split and LDLT in pediatric patients have the potential to decrease wait times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. The baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010 and 2019, 911 pediatric LT were included in the analysis (LD graft group, n = 508, split graft group, n = 403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22–138) days vs. 46 (16–108) days; p = 0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p = 0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-, 3-, and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10 kg or ≤10 years old receiving an LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Dalzell¹,

Vargas²,

Soltys³

et al. 2022

Transpl Int

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“…Graft rejection, which is more common in children, is associated with the need for additional medical procedures such as liver biopsies and hospital admissions 4,5 . Furthermore, an estimated 8% to 29% of patients who receive a liver transplant will require retransplantation, which has higher associated morbidity and mortality rates than the initial transplant 5–7 . In addition, posttransplant immunosuppression increases the risk of infections and malignant complications, 8–10 and can result in a significant burden for patients and caregivers.…”

Section: Introductionmentioning

confidence: 99%

Costs of pediatric liver transplantation among commercially insured and Medicaid-insured patients with cholestasis in the US

Miloh

Goldstein²,

Howard³

et al. 2023

Liver Transplantation

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Children with rare cholestatic liver diseases, such as Alagille syndrome, progressive familial intrahepatic cholestasis, and biliary atresia typically require liver transplantation (LT). The objective of this analysis was to assess the economic burden of LT on these patients. Health care resource utilization and costs associated with pediatric LT were retrospectively assessed using insurance claims data from the US IBM MarketScan Commercial and Medicaid databases collected between October 2015 and December 2019. Inclusion criteria were as follows: ≥1 procedure code for LT, <18 years old at transplant, and ≥6 months of insurance eligibility at baseline. A cholestatic liver disease population who received LT was selected in the absence of specific diagnosis codes by excluding other severe liver conditions (ie, acute liver failure, malignancy) and by excluding severely decompensated individuals requiring ICU admission before LT. Annualized rates were reported. Over a mean study duration of 1.8 years, 53 commercially insured and 100 Medicaid-insured children received LT, with mean (SD) ages at baseline of 6.9 (6.0) and 5.7 (5.4) years, respectively. During this period, commercially insured and Medicaid-insured patients had annualized means of 65.3 and 52.8 medical visits, respectively. Most were outpatient visits, although the burden of inpatient visits was also high, with mean inpatient stays (inclusive of LT stay) of 37.2 and 31.6 days per year, respectively. Commercially insured and Medicaid-insured patients averaged US$512,124 and $211,863 in medical costs and $26,998 and $15,704 in pharmacy costs, respectively. These costs remained substantial throughout the first year after transplant. Overall, pediatric LT resulted in substantial health care resource utilization and cost burden in both commercially- and Medicaid-insured patients. Novel targeted medications that negate the need for pediatric LT could decrease the associated morbidity and costs.

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“…The incidence of HAT in pediatric patients is higher than that in adult patients, ranging from 2% to 10%. Although improvements in surgical technique and pharmacological thrombosis prophylaxis have helped to decrease HAT rates, it is still one of the most frequent reasons for graft loss in pediatric recipients 5,6 …”

Section: Introductionmentioning

confidence: 99%

Time is of the essence: A single‐center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients

Gautier

Monakhov

Цирульникова

et al. 2020

Pediatric Transplantation

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Background: Impairment of hepatic arterial flow including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), and splenic artery steal syndrome (SASS) is potentially life-threatening complications. The proposed early diagnosis and urgent treatment strategy of graft arterial flow reduction aim to decrease morbidity and mortality. Methods: Pediatric patients with known hepatic arterial flow impairment were retrospectively reviewed. Patients were grouped by occlusive (HAT) and non-occlusive (HAS/SASS) arterial flow reduction. Patients with HAT were further divided in two groups based on the estimated maximal hepatic artery occlusion time ≤8 and >8 hours. Results: Impairment of hepatic arterial flow developed in 32 of 416 pediatric liver transplant recipients. HAT, HAS, and SASS incidences were 4.1% (n = 17), 2.2%(n = 9), and 1.4% (n = 6), respectively. Neither graft loss nor death occurred in the non-occlusive group. The probabilities of sepsis (OR, 1.7; 95% CI, 1.14-2.53; P=.008) and graft loss or death (OR, 1.42; 95% CI, 1.04-1.92; P=.046) were higher in the occlusive group. Patients with estimated maximal duration of hepatic artery occlusion ≤ 8 hours (n = 7; 41.2%) did not have ischemic-type biliary lesions and sepsis (P=.044 and 0.010, respectively) but had excellent 3-year graft survival compared with > 8 hours group (100% vs 40%; P=.037). Multivariate analysis revealed HAT manifestation by fever was associated with increased chances of graft loss or death. Conclusion:Occlusive arterial complications impose higher risks of graft loss and death. Thorough arterial supply monitoring by Doppler ultrasonography and urgent endovascular arterial flow restoration may salvage both graft and the recipient.

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Prognostic Factors in Pediatric Early Liver Retransplantation

Cited by 9 publications

References 27 publications

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

Costs of pediatric liver transplantation among commercially insured and Medicaid-insured patients with cholestasis in the US

Time is of the essence: A single‐center experience of hepatic arterial supply impairment management in pediatric liver transplant recipients

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