10 Years of pediatric liver transplantation

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

Research output: Contribution to journalArticle

38 Citations (Scopus)

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

Fingerprint

Liver Transplantation
Survival Rate
Pediatrics
Alagille Syndrome
Biliary Atresia
End Stage Liver Disease
Metabolic Diseases
Liver Diseases
Sepsis
Life Tables
Survival
Acute Liver Failure
Intraoperative Complications
Liver Failure
Azathioprine
Graft Survival
Immunosuppression
Cyclosporine
Accidents
Blood Vessels

Keywords

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

ASJC Scopus subject areas

  • Surgery

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

10 Years of pediatric liver transplantation. / Andrews, Walter; Sommerauer, John; Roden, Jay; Andersen, John; Conlin, Colleen; Moore, Paul.

In: Journal of Pediatric Surgery, Vol. 31, No. 5, 05.1996, p. 619-624.

Research output: Contribution to journalArticle

Andrews, W, Sommerauer, J, Roden, J, Andersen, J, Conlin, C & Moore, P 1996, '10 Years of pediatric liver transplantation', Journal of Pediatric Surgery, vol. 31, no. 5, pp. 619-624. https://doi.org/10.1016/S0022-3468(96)90660-0
Andrews, Walter ; Sommerauer, John ; Roden, Jay ; Andersen, John ; Conlin, Colleen ; Moore, Paul. / 10 Years of pediatric liver transplantation. In: Journal of Pediatric Surgery. 1996 ; Vol. 31, No. 5. pp. 619-624.
@article{045e5f324a5e46ceb091d5900bacc1d6,
title = "10 Years of pediatric liver transplantation",
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.",
keywords = "complications, Liver transplantation, mortality rate, pediatric, survival",
author = "Walter Andrews and John Sommerauer and Jay Roden and John Andersen and Colleen Conlin and Paul Moore",
year = "1996",
month = "5",
doi = "10.1016/S0022-3468(96)90660-0",
language = "English (US)",
volume = "31",
pages = "619--624",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - 10 Years of pediatric liver transplantation

AU - Andrews, Walter

AU - Sommerauer, John

AU - Roden, Jay

AU - Andersen, John

AU - Conlin, Colleen

AU - Moore, Paul

PY - 1996/5

Y1 - 1996/5

N2 - 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.

AB - 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.

KW - complications

KW - Liver transplantation

KW - mortality rate

KW - pediatric

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=0029916302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029916302&partnerID=8YFLogxK

U2 - 10.1016/S0022-3468(96)90660-0

DO - 10.1016/S0022-3468(96)90660-0

M3 - Article

C2 - 8861467

AN - SCOPUS:0029916302

VL - 31

SP - 619

EP - 624

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 5

ER -