Impact of surgical and immunological parameters in pediatric liver transplantation: A multivariate analysis in 500 consecutive recipients of primary grafts

Impact of surgical and immunological parameters in pediatric liver transplantation: A multivariate analysis in 500 consecutive recipients of primary grafts

To assess the respective impact of surgical and immunologic factors on patient/graft outcome and rejection after pediatric liver transplantation. Orthotopic liver transplantation (OLT) constitutes a validated therapeutic modality for acute liver failure and end-stage liver disease in children. Only...

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Bibliographic Details
Published in:Annals of surgery Vol. 239; no. 2; pp. 272 - 280
Main Authors: EVRARD, Veerle, OTTE, Jean-Bernard, SOKAL, Etienne, ROCHET, Jean-Stéphan, HACCOURT, Fabian, GENNARI, Fabrizio, LATINNE, Dominique, JAMART, Jacques, REDING, Raymond
Format: Journal Article
Language:English
Published: Hagerstown, MD Lippincott 01-02-2004
Subjects:
ABO Blood-Group System
Adolescent
Biological and medical sciences
Child
Child, Preschool
Female
General aspects
Graft Rejection - immunology
Graft Rejection - prevention & control
Graft Survival
Histocompatibility
Humans
Immunosuppressive Agents - administration & dosage
Infant
Liver Transplantation - immunology
Liver Transplantation - methods
Liver Transplantation - mortality
Male
Medical sciences
Multivariate Analysis
Original
Retrospective Studies
Survival Rate
Treatment Outcome
Human
Pediatrics
Liver
Recipient
Transplantation
Multivariate analysis
Medicine
Primitive
Treatment
Surgery
Primary
Graft
Parameter
Child
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Summary:To assess the respective impact of surgical and immunologic factors on patient/graft outcome and rejection after pediatric liver transplantation. Orthotopic liver transplantation (OLT) constitutes a validated therapeutic modality for acute liver failure and end-stage liver disease in children. Only a few large studies of factors influencing outcome of pediatric OLT are available in the literature. Studies considering the impact of rejection on graft outcome are scarce in adult OLT and are not even available for pediatric recipients. Five hundred consecutive pediatric recipients (<15 years) of a primary OLT performed between March 1984 and July 2000 were retrospectively reviewed. The main indication was biliary atresia (n = 328). A living related donor graft was used from July 1993 onwards in 82 children (16%). Survival was calculated and multivariate analysis was performed. Actuarial survival rates at 1, 5, and 10 years were 85%, 81%, and 79% for patients, and 76%, 71%, and 70% for grafts, respectively. At the multivariate analysis, only 3 factors were found to be independently correlated with better patient survival: year of transplantation (P = 0.001), pretransplant diagnosis (P < 0.001, worst results for liver tumors), and ABO matching (P < 0.001, worst results for ABO incompatibility). Similarly, 3 factors were independently correlated with better rejection-free graft survival: tacrolimus as primary immunosuppressant (P < 0.001), a negative T-cell crossmatch (P = 0.016), and younger age of the donor (P < 0.001). Pediatric OLT constitutes a complex undertaking with multifactorial impact on results: (1). a strong learning curve effect was shown to impact on overall results; (2). pediatric liver tumors still represent a challenging indication for OLT; (3). primary immunoprophylaxis with tacrolimus provided a lower rejection incidence; (4). the younger donor age effect deserves further immunologic investigations.
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ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000108681.24374.02