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 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(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 at15 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.
Adolescent; Adult; Child; Child, Preschool; Databases, Factual; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Kaplan-Meier Estimate; Liver Transplantation; Male; Middle Aged; Pediatrics; Retrospective Studies; Survival Rate; Time Factors; Tissue and Organ Procurement; Treatment Outcome; United States; Young Adult
adolescents; chronic rejection; long-term results; pediatric liver transplantation
Ekong UD, Gupta NA, Urban R, Andrews WS. 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. Pediatr Transplant. 2019;23(6):e13523. doi:10.1111/petr.13523