10 Years of pediatric liver transplantation

Walter Andrews, John Sommerauer, Jay Roden, John Andersen, Colleen Conlin, Paul Moore

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Purpose: Pediatric liver transplantation is an accepted therapy for end- stage liver disease, but little long-term data exist. Methods: From October 1984 to October 1994, 202 patients underwent a total of 225 liver transplantations. There were 98 boys and 104 girls, the average age was 5.1 ± 4.9 (range, 0.2 to 19.1) years. Thirty (16%) were under 1 year of age. The diseases that required transplantation included biliary atresia (BA) (45%), metabolic liver disease (MLD) (9.9%), acute hepatic failure (6.9%), and Alagille's syndrome (AS) (5.4%). Originally the immunosuppression was cyclosporine- and steroid-based; the later regimens also included azathioprine and antilymphocyte preparations. All reported survival rates were derived from life-table analysis. Results: The patient survival rates at 1, 5, and 10 years were 76%, 70%, and 61%; the retransplantation rate was 11%. The respective graft survival rates were 71%, 63%, and 59%. There were 60 deaths; 48 (81%) occurred in the first year. These first-year deaths were from sepsis (20; 42%), central nervous system problems (5; 11%), intraoperative complications (4; 8%), lymphoproliferative disease (LPD) (2; 4%), rejection (2; 4%), primary nonfunction (2; 4%), and miscellaneous other causes (7; 15%). There were 12 deaths after the first year, from LPD (3; 25%), sepsis (1; 8%), rejection (2; 18%), cancer (1; 9%), secondary hepatic failure (1; 9%), cerebral vascular accident (1; 9%), or pre- or postoperative complications (3; 25%). Compared with the overall survival rate, patients with MLD had a better chance of survival (83%; P < .012) than did those with AS (45%; P < .001). The 5- and 10-year survival rates for patients with BA were 61% and 58%. Over the past 2 years, the survival rate has increased (87% v 72%; P < .05) as early septic deaths have decreased (from 2.6 to 1.0 per year). Conclusion: Liver transplantation is effective treatment for end- stage liver disease. Decreasing the number of early septic deaths has improved the chance of survival, and better diagnosis and treatment of LPD would improve the late survival rate.

Original languageEnglish (US)
Pages (from-to)619-624
Number of pages6
JournalJournal of Pediatric Surgery
Volume31
Issue number5
DOIs
StatePublished - May 1996

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Keywords

  • Liver transplantation
  • complications
  • mortality rate
  • pediatric
  • survival

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Andrews, W., Sommerauer, J., Roden, J., Andersen, J., Conlin, C., & Moore, P. (1996). 10 Years of pediatric liver transplantation. Journal of Pediatric Surgery, 31(5), 619-624. https://doi.org/10.1016/S0022-3468(96)90660-0