OBJECTIVE: To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors. SUMMARY BACKGROUND DATA: Graft failure after transplantation remains an important problem. It results in patient death or retransplantation, resulting in lower survival rates. METHODS: A series of 157 transplantations in 120 children was analyzed. Graft loss was categorized as early (within 1 month) and late (after 1 month). Risk factors were identified by analyzing recipient, donor, and transplantation variables. RESULTS: Kaplan-Meier 1-month and 1-, 3-, and 5-year patient survival rates were 85%, 82%, 77%, and 71%, respectively. Graft survival rates were 71%, 64%, 59%, and 53%, respectively. Seventy-one of 157 grafts (45%) were lost: 18 (25%) by death of patients with functioning grafts and 53 (75%) by graft-related complications. Forty-five grafts (63%) were lost early after transplantation. Main causes of early loss were vascular complications, primary nonfunction, and patient death. Main cause of late graft loss was fibrosis/cirrhosis, mainly as a result of biliary complications or unknown causes. Child-Pugh score, anhepatic phase, and urgent transplantation were risk factors for early loss. Donor age, donor/recipient weight ratio, blood loss, and technical-variant liver grafts were risk factors for late loss. CONCLUSIONS: To prevent graft loss after pediatric liver transplantation, potential recipients should be referred early so they can be transplanted in an earlier phase of their disease. Technical-variant liver grafts are risk factors for graft survival. The logistics of the operation need to be optimized to minimize the length of the anhepatic phase.
OBJECTIVE: To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors. SUMMARY BACKGROUND DATA: Graft failure after transplantation remains an important problem. It results in patientdeath or retransplantation, resulting in lower survival rates. METHODS: A series of 157 transplantations in 120 children was analyzed. Graft loss was categorized as early (within 1 month) and late (after 1 month). Risk factors were identified by analyzing recipient, donor, and transplantation variables. RESULTS: Kaplan-Meier 1-month and 1-, 3-, and 5-year patient survival rates were 85%, 82%, 77%, and 71%, respectively. Graft survival rates were 71%, 64%, 59%, and 53%, respectively. Seventy-one of 157 grafts (45%) were lost: 18 (25%) by death of patients with functioning grafts and 53 (75%) by graft-related complications. Forty-five grafts (63%) were lost early after transplantation. Main causes of early loss were vascular complications, primary nonfunction, and patientdeath. Main cause of late graft loss was fibrosis/cirrhosis, mainly as a result of biliary complications or unknown causes. Child-Pugh score, anhepatic phase, and urgent transplantation were risk factors for early loss. Donor age, donor/recipient weight ratio, blood loss, and technical-variant liver grafts were risk factors for late loss. CONCLUSIONS: To prevent graft loss after pediatric liver transplantation, potential recipients should be referred early so they can be transplanted in an earlier phase of their disease. Technical-variant liver grafts are risk factors for graft survival. The logistics of the operation need to be optimized to minimize the length of the anhepatic phase.
Authors: J Pruim; W F van Woerden; E Knol; I J Klompmaker; K M de Bruijn; G G Persijn; M J Slooff Journal: Transplant Proc Date: 1989-02 Impact factor: 1.066
Authors: T V Cacciarelli; I Dvorchik; G V Mazariegos; D Gerber; A B Jain; J J Fung; J Reyes Journal: Transplantation Date: 1999-09-15 Impact factor: 4.939
Authors: O A Achilleos; D F Mirza; D Talbot; P McKiernan; S V Beath; B K Gunson; J W Freeman; A D Mayer; P McMaster; J A Buckels; D A Kelly Journal: Liver Transpl Surg Date: 1999-09
Authors: E Sieders; P M Peeters; E M TenVergert; C M Bijleveld; K P de Jong; J H Zwaveling; G A Boersma; M J Slooff Journal: Transplantation Date: 1999-08-27 Impact factor: 4.939
Authors: J A Goss; C R Shackleton; S V McDiarmid; M Maggard; K Swenson; P Seu; J Vargas; M Martin; M Ament; J Brill; R Harrison; R W Busuttil Journal: Ann Surg Date: 1998-09 Impact factor: 12.969
Authors: Ivan R Diamond; Annie Fecteau; J Michael Millis; Julian E Losanoff; Vicky Ng; Ravinder Anand; Changhong Song Journal: Ann Surg Date: 2007-08 Impact factor: 12.969