Survival After Pediatric Liver Transplantation

Austin, Mary T.; Feurer, Irene D.; Chari, Ravi S.; Gorden, D. Lee; Wright, J. Kelly; Pinson, C. Wright

doi:10.1001/archsurg.140.5.465

Cited by 44 publications

(19 citation statements)

References 14 publications

(13 reference statements)

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“…As developed recently in the American allocation system, PELD scores comparison did not show any statistical difference between groups DD and LD, suggesting that LD recipients were as ill as DD recipients at the time of LT (16,17). The benefit of LD on posttransplant patient and graft survival has also been reported on larger database from the UNOS (19). The observations made in this study constitute, however, additional information beyond that given in the latest scientific registry of transplant recipients (SRTR) analysis which shows better outcomes for children transplanted with LD livers only in less than 1 year of age (20).…”

Section: Discussionmentioning

confidence: 60%

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Bourdeaux

Darwish

Jamart

et al. 2007

American Journal of Transplantation

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Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT).We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD) (n = 135). Demographic, surgical and immunological variables were compared, and respective impact on posttransplant complications was studied using a multivariate analysis. Five-year patient survival rates were 92% and 85% for groups LD and DD, respectively (p = 0.181), the corresponding graft survival rates being 89% and 77% (p = 0.033). At multivariate analysis: (1) type of donor (DD) was correlated with higher rate of artery thrombosis (p < 0.012); (2) biliary complication rate at 5 years was 29% and 23% for groups LD and DD, respectively (p = 0.451); (3) lower acute rejection incidence could be correlated with type of donor (DD) (p = 0.001), and immunosuppressive therapy (tacrolimus) (p < 0.001). We conclude that (1) according to the multivariate analysis, LT with LD provided similar patient and graft outcome, when compared to DD; (2) a higher rate of artery thrombosis and a lower rate of rejection were observed in group DD; (3) this study comfirms the efficacy of tacrolimus for immunoprophylaxis, whatever the type of organ donor is.

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Section: Discussionmentioning

confidence: 60%

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Bourdeaux

Darwish

Jamart

et al. 2007

American Journal of Transplantation

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“…These advantages may positively affect the long-term survival of LDLT. Moreover, Austin et al [45] also reports the long-term survival rate in the paediatric population is better with LDLT than DDLT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Wen

et al. 2011

PLoS ONE

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Background/AimsThe number of people undergoing living donor liver transplantation (LDLT) has increased rapidly in many transplant centres. Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT.MethodsA total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study. LDLT was performed in 128 patients, and DDLT was performed in 221 patients. Pre- and intra-operative variables for the two groups were compared. Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV) recurrence, long-term survival rate and outcomes of emergency transplantation.ResultsThe waiting times were 22.10±15.31 days for the patients undergoing LDLT versus 35.81±29.18 days for the patients undergoing DDLT. The cold ischemia time (CIT) was 119.34±19.75 minutes for the LDLT group and 346±154.18 for DDLT group. LDLT group had higher intraoperative blood loss, but red blood cell (RBC) transfusion was not different. Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV) recurrence and long-term survival rates were noted. LDLT patients suffered a higher incidence of biliary complications in the early postoperative days. However, during the long-term follow-up period, biliary complication rates were similar between the two groups. The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation. However, no significant difference was observed between emergency LDLT and emergency DDLT.ConclusionsPatients undergoing LDLT achieved similar outcomes to patients undergoing DDLT. Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication rate was similar during the long-term follow-up period.

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“…These data clearly show that the extensive use of TVLT in pediatric patient has achieved a significant success in expanding the donor pool for children. Although we could not compare the LLT to WLT due to lack of sufficient data, there are four articles based on the UNOS database demonstrating that patients undergoing LLT experience superior survivals compared to patients treated with WLT [ 42 – 45 ]. Therefore, TVLT not only expands the donor pool but also facilitates earlier transplant, providing an increased chance of survival [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Technical Variant Liver Transplantation versus Whole Liver Transplantation for Pediatric Patients: A Meta-Analysis

Zhao

Wang

et al. 2015

PLoS ONE

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ObjectiveTo overcome the shortage of appropriate-sized whole liver grafts for children, technical variant liver transplantation has been practiced for decades. We perform a meta-analysis to compare the survival rates and incidence of surgical complications between pediatric whole liver transplantation and technical variant liver transplantation.MethodsTo identify relevant studies up to January 2014, we searched PubMed/Medline, Embase, and Cochrane library databases. The primary outcomes measured were patient and graft survival rates, and the secondary outcomes were the incidence of surgical complications. The outcomes were pooled using a fixed-effects model or random-effects model.ResultsThe one-year, three-year, five-year patient survival rates and one-year, three-year graft survival rates were significantly higher in whole liver transplantation than technical variant liver transplantation (OR = 1.62, 1.90, 1.65, 1.78, and 1.62, respectively, p<0.05). There was no significant difference in five-year graft survival rate between the two groups (OR = 1.47, p = 0.10). The incidence of portal vein thrombosis and biliary complications were significantly lower in the whole liver transplantation group (OR = 0.45 and 0.42, both p<0.05). The incidence of hepatic artery thrombosis was comparable between the two groups (OR = 1.21, p = 0.61).ConclusionsPediatric whole liver transplantation is associated with better outcomes than technical variant liver transplantation. Continuing efforts should be made to minimize surgical complications to improve the outcomes of technical variant liver transplantation.

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Survival After Pediatric Liver Transplantation

Cited by 44 publications

References 14 publications

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Outcomes of Technical Variant Liver Transplantation versus Whole Liver Transplantation for Pediatric Patients: A Meta-Analysis

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