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

Robert S. Venick, Douglas G. Farmer, Sue V. McDiarmid, John P. Duffy, Sherilyn A. Gordon, Hasan Yersiz, Johnny C. Hong, Jorge H. Vargas, Marvin E. Ament, Ronald W. Busuttil

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background: Infants (<12 months) who require liver transplantation (LTx) represent a particularly challenging and understudied group of patients. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)600-605
Number of pages6
JournalTransplantation
Volume89
Issue number5
DOIs
StatePublished - Mar 2010

Keywords

  • Infant
  • Liver transplantation
  • Pediatric
  • Survival

ASJC Scopus subject areas

  • Transplantation

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