Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases

• Published in: Transplantation Vol. 89; no. 5; p. 600
• Main Authors: Venick, Robert S, Farmer, Douglas G, McDiarmid, Sue V, Duffy, John P, Gordon, Sherilyn A, Yersiz, Hasan, Hong, Johnny C, Vargas, Jorge H, Ament, Marvin E, Busuttil, Ronald W
• Format: Journal Article
• Language: English
• Published: United States 15.03.2010
• Subjects: Body Size; Cholestasis - surgery; Cohort Studies; Creatinine - blood; Decision Making; Ethnic Groups; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Survival - physiology; Humans; Infant; Liver Failure - surgery; Liver Transplantation - mortality; Liver Transplantation - physiology; Male; Predictive Value of Tests; Renal Replacement Therapy - statistics & numerical data; Retrospective Studies; Survival Rate; Time Factors
• ISSN: 1534-6080
• DOI: 10.1097/tp.0b013e3181c5cdc1

Infants (<12 months) who require liver transplantation (LTx) represent a particularly challenging and understudied group of patients. This retrospective study aimed to describe a large single-center experience of infants who received isolated LTx, illustrate important differences in infants versus older children, and identify pretransplant factors which influence survival. More than 25 pre-LTx demographic, laboratory, and operative variables were analyzed using the Log-rank test and Cox proportional hazards model. Between 1984 and 2006, 216 LTx were performed in 186 infants with a mean follow-up time of 62 months. Median age at LTx was 9 months, the majority had cholestatic liver disease, were hospitalized pre-LTx, and received whole grafts. Leading indications for re-LTx (n=30) included vascular complications (43%) and graft nonfunction (40%), whereas leading causes of death were sepsis and multiorgan failure. One-, 5-, and 10-year graft and patient survivals were 75%/72%/68% and 79%/77%/75%, respectively. Relative to older pediatric recipients, infants had worse overall patient survival (P=0.05). The following were significant univariate predictors of graft loss: age less than 6 months and reduced cadaveric grafts; and of patient loss: age less than 6 months, calculated CrCl less than 90, pre-LTx hospitalization, pre-LTx mechanical ventilation, repeat LTx, infants transplanted for reasons other than cholestatic liver disease, and patients transplanted between 1984 and 1994. Long-term outcomes for infants undergoing LTx are excellent and have improved over time. As the largest, single-center analysis of LTx in infants, this study elucidates a unique set of predictors that can aid in medical decision making.