A recent retrospective study (SA Taylor et al. J Pediatr 2020; 219; 89-97) examined patients enrolled in the Society of Pediatric Liver Transplantation (SPLIT) registry, including 547 before 2002 and 1477 after 2002.
- Before 2002, patient and graft survival were 81% and 90%.
- After 2002, patient and graft survival were 90% and 97%. This improvement is perhaps more impressive as there was evidence of increased disease severity at time of transplantation in the later cohort.
- The reasons for these improved outcomes include reduced relisting for transplant, less rejection, less culture-proven infection, fewer reoperations, and less vascular complications (eg. hepatic artery thrombosis and portal vein thrombosis).
- Donor age (0-5 months) was a risk factor for graft loss; compared to 1-17 years, the hazard ratio was 5.525. However, in the later group, recipient age of ≤11 months was no longer a risk factor for patient death.
- Bacterial infection or sepsis remain the leading cause of death after transplantation.
Due to improvement in survival, the authors note that some have advocated for primary liver transplantation instead of Kasai portoenterostomy. “A report of 626 patients with biliary atresia, of whom 50% underwent primary liver transplantation without Kasai portoenterostomy, demonstrated improved survival.” (JAMA Surg 2019; 154: 26-32)
My take: This information about survival is certainly encouraging –though many challenges remain, especially to improve comorbidities.
Related blog posts:
- What to Expect After Pediatric Liver Transplantation: Cognitive Function and Quality of Life
- 30 -Year Outcomes with Biliary Atresia
- Outcomes of Liver Transplantation in Small Infants
- “Big Improvements for Smallest Recipients” with Bad Liver Disease
- Pediatric Liver Transplantation: Past Time to Split
- Picking winners and losers with liver transplantation allocation
- AASLD/NASPGHAN 2014 Guidelines for Evaluation of Pediatric Liver Transplantation