Long-term outcomes and predictors in pediatric liver retransplantation
Historically, 9–29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipien...
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Published in | Pediatric transplantation Vol. 19; no. 8; pp. 866 - 874 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Blackwell Publishing Ltd
01.12.2015
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Abstract | Historically, 9–29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan–Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had “early” (≤30 days after primary transplant) and “late” retransplants. Eighty‐four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five‐yr follow‐up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long‐term immunosuppressant morbidity remains an opportunity for improvement. |
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AbstractList | Historically, 9–29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan–Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had “early” (≤30 days after primary transplant) and “late” retransplants. Eighty‐four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five‐yr follow‐up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long‐term immunosuppressant morbidity remains an opportunity for improvement. Historically, 9–29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan–Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had “early” (≤30 days after primary transplant) and “late” retransplants. Eighty‐four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five‐yr follow‐up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long‐term immunosuppressant morbidity remains an opportunity for improvement. Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan-Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had "early" (≤ 30 days after primary transplant) and "late" retransplants. Eighty-four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five-yr follow-up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long-term immunosuppressant morbidity remains an opportunity for improvement. |
Author | Soltys, Kyle A. Martin, Lillian Venkat, Veena Sindhi, Rakesh Mazariegos, George V. Dreyzin, Alexandra Bond, Geoffrey J. Lunz, John |
Author_xml | – sequence: 1 givenname: Alexandra surname: Dreyzin fullname: Dreyzin, Alexandra organization: University of Pittsburgh School of Medicine, PA, Pittsburgh, USA – sequence: 2 givenname: John surname: Lunz fullname: Lunz, John organization: Department of Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 3 givenname: Veena surname: Venkat fullname: Venkat, Veena organization: Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 4 givenname: Lillian surname: Martin fullname: Martin, Lillian organization: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 5 givenname: Geoffrey J. surname: Bond fullname: Bond, Geoffrey J. organization: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 6 givenname: Kyle A. surname: Soltys fullname: Soltys, Kyle A. organization: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 7 givenname: Rakesh surname: Sindhi fullname: Sindhi, Rakesh organization: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA – sequence: 8 givenname: George V. surname: Mazariegos fullname: Mazariegos, George V. email: George V. Mazariegos, Hillman Center for Pediatric Transplantation, 4401 Penn Avenue, Pittsburgh, PA 15224, USATel.: +1 412 692 6110Fax: +1 412 692 6116, george.mazariegos@chp.edu organization: Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA, Pittsburgh, USA |
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Cites_doi | 10.1016/j.surg.2008.06.029 10.1016/j.jpeds.2011.10.038 10.1002/hep.22686 10.1111/j.1399-3046.2010.01304.x 10.1002/lt.23826 10.1111/j.1600-6143.2007.02056.x 10.1016/j.transproceed.2012.05.010 10.1002/lt.21664 10.1542/peds.2008-1363 10.1111/j.1432-2277.2008.00807.x 10.1002/lt.23534 10.1002/lt.21981 10.1002/lt.21549 10.1097/MOT.0b013e32834a94e3 10.1002/lt.22025 10.1111/j.1399-3046.2010.01400.x |
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Keywords | graft survival retransplantation long-term outcomes pediatric liver transplantation |
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References_xml | – volume: 22 start-page: 416 year: 2009 end-page: 422 article-title: Liver retransplantation in children. A 21‐year single‐center experience publication-title: Transpl Int – volume: 15 start-page: 199 year: 2009 end-page: 207 article-title: Pediatric liver retransplantation: Outcomes and a prognostic scoring tool publication-title: Liver Transpl – volume: 18 start-page: 1333 year: 2012 end-page: 1342 article-title: Progressive graft fibrosis and donor‐specific human leukocyte antigen antibodies in pediatric late liver allografts publication-title: Liver Transpl – volume: 20 start-page: 514 year: 2014 end-page: 527 article-title: Antibody‐mediated rejection in liver transplantation: Current controversy and future directions publication-title: Liver Transpl – volume: 14 start-page: 1019 year: 2010 end-page: 1029 article-title: Identifying the futile pediatric liver retransplant in the PELD era publication-title: Pediatr Transplant – volume: 14 start-page: 417 year: 2010 end-page: 425 article-title: Liver retransplantation in children: The Atlanta experience publication-title: Pediatr Transplant – volume: 144 start-page: 762 year: 2008 end-page: 769 article-title: Optimization of liver grafts in liver retransplantation: A European single‐center experience publication-title: Surgery – volume: 14 start-page: 1582 year: 2008 end-page: 1587 article-title: Graft histology characteristics in long‐term survivors of pediatric liver transplantation publication-title: Liver Transpl – volume: 160 start-page: 820 year: 2012 end-page: 826 article-title: Health status of children alive 10 years after pediatric liver transplantation performed in the US and Canada: Report of the studies of pediatric liver transplantation experience publication-title: J Pediatr – volume: 44 start-page: 1526 year: 2012 end-page: 1529 article-title: Have we changed the liver retransplantation survival? publication-title: Transplant Proc – volume: 16 start-page: 515 year: 2011 end-page: 521 article-title: Cellular alloresponses for rejection‐risk assessment after pediatric transplant publication-title: Curr Opin Organ Transplant – volume: 49 start-page: 880 year: 2009 end-page: 886 article-title: Graft fibrosis after pediatric liver transplantation: Ten years of follow‐up publication-title: Hepatology – volume: 16 start-page: 259 year: 2010 end-page: 261 article-title: Human leukocyte antigen antibodies in liver retransplantation publication-title: Liver Transpl – volume: 8 start-page: 386 year: 2008 end-page: 395 article-title: Liver retransplantation in children: A SPLIT database analysis of outcome and predictive factors for survival publication-title: Am J Transplant – volume: 122 start-page: e1128 year: 2008 end-page: e1135 article-title: Outcomes of 5‐year survivors of pediatric liver transplantation: Report on 461 children from a North American multicenter registry publication-title: Pediatrics – volume: 16 start-page: 308 year: 2010 end-page: 313 article-title: Human leukocyte antigen cross‐match testing is important for liver retransplantation publication-title: Liver Transpl – ident: e_1_2_9_7_1 doi: 10.1016/j.surg.2008.06.029 – ident: e_1_2_9_9_1 doi: 10.1016/j.jpeds.2011.10.038 – ident: e_1_2_9_17_1 doi: 10.1002/hep.22686 – ident: e_1_2_9_2_1 doi: 10.1111/j.1399-3046.2010.01304.x – ident: e_1_2_9_12_1 doi: 10.1002/lt.23826 – ident: e_1_2_9_5_1 doi: 10.1111/j.1600-6143.2007.02056.x – ident: e_1_2_9_6_1 doi: 10.1016/j.transproceed.2012.05.010 – ident: e_1_2_9_8_1 doi: 10.1002/lt.21664 – ident: e_1_2_9_15_1 doi: 10.1542/peds.2008-1363 – ident: e_1_2_9_4_1 doi: 10.1111/j.1432-2277.2008.00807.x – ident: e_1_2_9_13_1 doi: 10.1002/lt.23534 – ident: e_1_2_9_14_1 doi: 10.1002/lt.21981 – ident: e_1_2_9_16_1 doi: 10.1002/lt.21549 – ident: e_1_2_9_10_1 doi: 10.1097/MOT.0b013e32834a94e3 – ident: e_1_2_9_11_1 doi: 10.1002/lt.22025 – ident: e_1_2_9_3_1 doi: 10.1111/j.1399-3046.2010.01400.x |
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Snippet | Historically, 9–29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently... Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently... |
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SubjectTerms | Adolescent Child Child, Preschool Female Follow-Up Studies Graft Survival Humans Infant Infant, Newborn Kaplan-Meier Estimate Liver Transplantation - mortality long-term outcomes Male Outcome Assessment (Health Care) pediatric liver transplantation Postoperative Complications - epidemiology Postoperative Complications - etiology Proportional Hazards Models Reoperation - mortality retransplantation Retrospective Studies Risk Factors Young Adult |
Title | Long-term outcomes and predictors in pediatric liver retransplantation |
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