Yu-Gang Lu1,2, Zhi-Ying Pan2, Song Zhang2, Ye-Feng Lu3, Wei Zhang4,5, Long Wang6, Xiao-Yan Meng7, Wei-Feng Yu2. 1. Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China. 2. Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China. 3. Department of Hepatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China. 4. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, 200433, China. 5. Fudan University Library, Fudan University, Shanghai, 200433, China. 6. Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, 100853, China. 7. Department of Anesthesiology, Eastern Hepatobiliary Surgical Hospital, Second Military Medical University, Shanghai, 200433, China.
Abstract
BACKGROUND: Living donor liver transplantation (LDLT) in children has achieved promising outcomes during the past few decades.{B, 2014 #448;A, 2007 #644} However, it still poses various challenges. This study aimed to analyze perioperative risk factors for postoperative death in pediatric LDLT. METHODS: We retrospectively analyzed medical records of pediatric patients who underwent LDLT surgery from January 1, 2014 to December 31, 2016 in our hospital. Predictors of mortality following LDLT were analyzed in 430 children. Cox regression and Kaplan-Meier curve analysis were used for covariates selection. A nomogram was developed to estimate overall survival probability. The performance of the nomogram was assessed using calibration curve, decision curves analysis (DCA) and time-dependent receiver operating characteristic (ROC) curve. RESULTS: Among the 430 patients in this cohort (median [IQR] age, 7 [6.10] months; 189 [43.9%] female; 391 [90.9%] biliary atresia), the overall survival was 91.4% (95%CI; 89.2, 94.4), and most of the death events (36/37) happened within 6 months after the surgery. Multivariate analysis indicated that the Pediatric End-stage Liver Disease (PELD) score, neutrophil lymphocyte ratio (NLR), graft-to-recipient weight ratio (GRWR) and intraoperative norepinephrine (NE) infusion were independent prognostic factors. A novel nomogram was developed based on these prognostic factors. The C-index for the final model was 0.764 (95%CI; 0. 701, 0.819). DCA and time-dependent ROC suggested that this novel nomogram performed well at predicting mortality of pediatric LDLT. CONCLUSIONS: We identified several perioperative risk factors for mortality of pediatric LDLT. And the newly developed nomogram can be a convenient individualized tool in estimating the prognosis of pediatric LDLT.
BACKGROUND: Living donor liver transplantation (LDLT) in children has achieved promising outcomes during the past few decades.{B, 2014 #448;A, 2007 #644} However, it still poses various challenges. This study aimed to analyze perioperative risk factors for postoperative death in pediatric LDLT. METHODS: We retrospectively analyzed medical records of pediatric patients who underwent LDLT surgery from January 1, 2014 to December 31, 2016 in our hospital. Predictors of mortality following LDLT were analyzed in 430 children. Cox regression and Kaplan-Meier curve analysis were used for covariates selection. A nomogram was developed to estimate overall survival probability. The performance of the nomogram was assessed using calibration curve, decision curves analysis (DCA) and time-dependent receiver operating characteristic (ROC) curve. RESULTS: Among the 430 patients in this cohort (median [IQR] age, 7 [6.10] months; 189 [43.9%] female; 391 [90.9%] biliary atresia), the overall survival was 91.4% (95%CI; 89.2, 94.4), and most of the death events (36/37) happened within 6 months after the surgery. Multivariate analysis indicated that the Pediatric End-stage Liver Disease (PELD) score, neutrophil lymphocyte ratio (NLR), graft-to-recipient weight ratio (GRWR) and intraoperative norepinephrine (NE) infusion were independent prognostic factors. A novel nomogram was developed based on these prognostic factors. The C-index for the final model was 0.764 (95%CI; 0. 701, 0.819). DCA and time-dependent ROC suggested that this novel nomogram performed well at predicting mortality of pediatric LDLT. CONCLUSIONS: We identified several perioperative risk factors for mortality of pediatric LDLT. And the newly developed nomogram can be a convenient individualized tool in estimating the prognosis of pediatric LDLT.