20‐ to 25‐year patient and graft survival following a single pediatric liver transplant—Analysis of the United Network of Organ Sharing database: Where to go from here
To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year p...
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Published in | Pediatric transplantation Vol. 23; no. 6; pp. e13523 - n/a |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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01.09.2019
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Abstract | To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age (P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age (P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age (P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection. |
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AbstractList | To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age (P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age (P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age (P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection. To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age ( P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age ( P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age ( P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection. To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17 years of age compared to those transplanted at <5 years of age (P < 0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5 and 11‐15 years of age (P ≤ 0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17 years of age compared to those transplanted at <5, 5‐10, and 11‐15 years of age (P ≤ 0.001). Infection as a cause of death occurred either early or >15 years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25 years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection. |
Author | Urban, Read Gupta, Nitika A. Ekong, Udeme D. Andrews, Walter S. |
Author_xml | – sequence: 1 givenname: Udeme D. orcidid: 0000-0002-3312-112X surname: Ekong fullname: Ekong, Udeme D. email: udeme.ekong@yale.edu organization: Yale University School of Medicine – sequence: 2 givenname: Nitika A. orcidid: 0000-0002-6171-4731 surname: Gupta fullname: Gupta, Nitika A. organization: Emory University – sequence: 3 givenname: Read surname: Urban fullname: Urban, Read organization: United Network for Organ Sharing – sequence: 4 givenname: Walter S. orcidid: 0000-0003-0196-9895 surname: Andrews fullname: Andrews, Walter S. organization: Children's Mercy Hospitals & Clinics |
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Cites_doi | 10.1097/SLA.0000000000001094 10.1111/ajt.13184 10.1097/00007890-200203270-00020 10.1097/TP.0000000000001709 10.1111/j.1399-3046.2008.00923.x 10.1111/petr.12464 10.1002/hep.510310337 10.1097/00007890-200009150-00001 10.1111/ctr.13227 10.1111/ajt.14276 10.1097/TP.0000000000001689 10.1111/ajt.12276 10.1016/j.jceh.2017.10.003 10.1111/ajt.14626 10.1097/01.tp.0000258599.65257.a6 10.1016/j.clinre.2013.10.009 10.1097/TP.0b013e3181b2a0e0 10.1002/lt.23393 10.1111/j.1600-6143.2010.03126.x 10.1111/j.1399-3046.2010.01357.x 10.1111/j.1399-3046.2010.01349.x 10.1016/j.jpeds.2011.10.038 10.1111/petr.12465 10.1111/j.1600-6143.2007.01893.x 10.1016/S0041-1345(00)02563-X 10.1002/lt.23997 10.1111/j.1399-3046.2005.00451.x 10.1053/jlts.2002.34149 10.1097/MPG.0000000000002196 |
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SubjectTerms | adolescents Age Children chronic rejection Graft rejection Liver transplantation Liver transplants long‐term results pediatric liver transplantation Pediatrics Survival Teenagers |
Title | 20‐ to 25‐year patient and graft survival following a single pediatric liver transplant—Analysis of the United Network of Organ Sharing database: Where to go from here |
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