Three decades' analysis of pediatric liver transplantation outcomes reveals limited long‐term improvements

Abstract

Background The aim of this study was to assess improvements in long‐term survival of pediatric patients after liver transplantation by analyzing outcomes in transplant recipients who survived beyond 1 year after transplantation. There has been a marked increase in the 1‐year survival of pediatric patients, from 78% in transplant recipients between 1987 and 1990 to 95% in transplant recipients between 2011 and 2017. The long‐term outcomes have not seen a similar trend, creating a disparity that warrants analysis. Methods We analyzed 13 753 pediatric patients who survived for 1 year after receiving orthotopic liver transplantation between 1987 and 2017. The study period was divided into six eras. Outcomes were analyzed using the Kaplan–Meier method for time‐to‐event analysis, and multivariable Cox regression. Results There were no significant gains in long‐term outcomes among 1‐year survivors over the past three decades. Log‐rank tests for equality of survivor functions between each era and 1987–1990 were not statistically significant. Cause of death analysis revealed that although infections caused 20.6% of deaths in patients transplanted between 1987 and 1990, this number dropped to 5.6% in those transplanted between 2011 and 2017 (p = .01). Malignancy caused 10.6% of deaths in 1987–1990 but caused 22.2% of the deaths in 2011–2017 (p = .04). Conclusion Despite the gratifying gains in short‐term survival of pediatric patients, 1‐year survivors have no significant improvements in long‐term survival after undergoing a liver transplantation. Long‐term sequelae of immunosuppression, such as malignancy and infection, continue to be the most common causes of death. This study highlights the necessity for better long‐term management of immunosuppression.