Progress in pediatric liver transplantation—The Birmingham experience

Talbot, David; Achilleos, Orthodoxos; Gunson, Bridget K.; McKiernan, Patrick; Beath, S. V.; Kelly, Déirdre; Buckels, J. A. C.; Mayer, A. D.

doi:10.1016/s0022-3468(97)90011-7

Cited by 10 publications

(7 citation statements)

References 15 publications

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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%

See 1 more Smart Citation

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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“…19 20 Similar progress has occurred in intestinal and liver transplantation, 21 22 where new approaches and operations may improve the quality of life and functional outcome for affected infants.…”

Section: Surgical Gastroenterologymentioning

confidence: 88%

“…The Pittsburgh group has reported the survival of 55% of patients undergoing intestinal transplantation, with most living at home and off parenteral nutritional support 21. Liver transplantation in children continues to achieve excellent results22; 80% survival has been recently reported by the Birmingham group in the United Kingdom 22. The use of split liver transplantation (whole liver divided into two grafts) has led to a further increase in the donor pool 27…”

Section: Surgical Gastroenterologymentioning

confidence: 99%

Recent advances: Paediatric surgery

Losty

1999

BMJ

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“…Morbidity is high; sepsis (70%), rejection (60%), vascular thrombosis (10%), and biliary complications (20%) are expected, but after increased medical and surgical experience, technical problems such as primary graft non-function and vascular thrombosis are now almost non-existent, and the retransplantation rates in children have fallen. 32 The difficult problem of acute and chronic rejection, which historically is less common in children than in adults has improved after advances in immunosuppression with drugs which are more easily absorbed such as cyclosporin microemulsion (Neoral) 33 or more potent such as tacrolimus which has reduced the incidence of chronic rejection. 34 As long term survival increases, attention has now focused on the quality of life achieved by children undergoing transplantation.…”

Section: Complications and Outcomementioning

confidence: 99%

Managing liver failure

Kelly¹

2002

Postgraduate Medical Journal

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Liver disease is rare in childhood, but important new developments have altered the natural history and outcome. It is important that clinicians are aware of these diseases and their management. Acute liver failure is most often due to viral hepatitis, paracetamol overdose, or inherited metabolic liver disease. The clinical presentation includes jaundice, coagulopathy, and encephalopathy. Early diagnosis is necessary to prevent complications such as cerebral oedema, gastrointestinal bleeding, and renal failure. Early supportive management, in particular intravenous N-acetylcysteine, may be effective but liver transplantation is usually the definitive treatment and thus early referral to a specialist unit for liver transplantation is mandatory. Chronic liver failure may be due to unresolved neonatal liver disease, either inherited biliary hypoplasia or extrahepatic biliary atresia, while in older children, autoimmune liver disease or cystic fibrosis are the commonest causes. Treatment includes specific medication, nutritional support, and liver transplantation, which now has a 90% survival with good quality life.

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Progress in pediatric liver transplantation—The Birmingham experience

Cited by 10 publications

References 15 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

Recent advances: Paediatric surgery

Managing liver failure

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