Angus W Jeffrey1, Gary P Jeffrey1,2, Michael Stormon3,4, Gordon Thomas3,4, Edward O'Loughlin3,4, Albert Shun3,4, Winita Hardikar5, Robert Jones6,7, John McCall8,9, Helen Evans9, Graham Starkey6,7, Peter Hodgkinson10,11, Looi C Ee12, David Moore13, Catherine Mews14, Geoff W McCaughan15,16, Peter W Angus6,7, Alan J Wigg17, Michael Crawford4,15, Jonathan Fawcett10,11. 1. Sir Charles Gairdner Hospital, Perth, WA. 2. The University of Western Australia, Perth, WA. 3. Australian National Liver Transplantation Service, Children's Hospital at Westmead, Sydney, NSW. 4. The University of Sydney, Sydney, NSW. 5. Royal Children's Hospital, Melbourne, VIC. 6. Victorian Liver Transplant Unit, Austin Hospital, Melbourne, VIC. 7. Victorian Liver Transplant Unit, Royal Children's Hospital, Melbourne, VIC. 8. New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand. 9. Starship Children's Health, Auckland, New Zealand. 10. Queensland Liver Transplantation Service, Princess Alexandra Hospital, Brisbane, QLD. 11. The University of Queensland, Brisbane, QLD. 12. Lady Cilento Children's Hospital, Brisbane, QLD. 13. Women's and Children's Hospital, Adelaide, SA. 14. Perth Children's Hospital, Perth, WA. 15. Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW. 16. Sydney Medical School, , the University of Sydney, Sydney, NSW. 17. South Australian Liver Transplantation Service, Flinders Medical Centre, Adelaide, SA.
Abstract
OBJECTIVE: To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986-2017; to determine the factors that influence survival. DESIGN: Retrospective cohort analysis (registry data). SETTING, PARTICIPANTS: Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986-2017, in all four paediatric and six adult liver transplantation centres in the two countries. MAIN OUTCOME MEASURES: Graft and patient survival at one, 5, 10 and 15 years. RESULTS: 142 liver retransplantations were undertaken in children (59 during 1986-2000, 83 during 2001-2017). Kaplan-Meier survival analysis indicated that survival was significantly greater during 2001-2017 than 1986-2000 (P < 0.001). During 2001-2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03-1.4 years) during 1986-2000, and 1.8 years (IQR, 0.1-6.8 years) during 2001-2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001-2017 (35 of 83, 42%) than 1986-2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation. CONCLUSION: Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.
OBJECTIVE: To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986-2017; to determine the factors that influence survival. DESIGN: Retrospective cohort analysis (registry data). SETTING, PARTICIPANTS: Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986-2017, in all four paediatric and six adult liver transplantation centres in the two countries. MAIN OUTCOME MEASURES: Graft and patient survival at one, 5, 10 and 15 years. RESULTS: 142 liver retransplantations were undertaken in children (59 during 1986-2000, 83 during 2001-2017). Kaplan-Meier survival analysis indicated that survival was significantly greater during 2001-2017 than 1986-2000 (P < 0.001). During 2001-2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03-1.4 years) during 1986-2000, and 1.8 years (IQR, 0.1-6.8 years) during 2001-2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001-2017 (35 of 83, 42%) than 1986-2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation. CONCLUSION: Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.
Authors: Simon Moosburner; Leke Wiering; Safak Gül-Klein; Paul Ritschl; Tomasz Dziodzio; Nathanael Raschzok; Christian Witzel; Alexander Gratopp; Stephan Henning; Philip Bufler; Moritz Schmelzle; Georg Lurje; Wenzel Schöning; Johann Pratschke; Brigitta Globke; Robert Öllinger Journal: J Clin Med Date: 2022-02-09 Impact factor: 4.241