Graft survival in pediatric liver transplantation

Max R. Langham, Andreas G. Tzakis, Regino Gonzalez-Peralta, John F. Thompson, Charles B. Rosen, Jose R. Nery, Alan I. Reed, Philip Ruiz, Willem J. VanderWerf, Alan Hemming, Richard J. Howard

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Abstract

Background/Purpose: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation. Methods: Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12). Results: One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36%) children were less than 1 year of age at time of transplant, and 80 (55%) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) grafts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P = .06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P < .01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival. Conclusions: The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.

Original languageEnglish (US)
Pages (from-to)1205-1209
Number of pages5
JournalJournal of Pediatric Surgery
Volume36
Issue number8
DOIs
StatePublished - 2001

Fingerprint

Graft Survival
Liver Transplantation
Pediatrics
Transplants
Survival Rate
Living Donors
Liver
Life Tables
Liver Diseases

Keywords

  • Liver transplantation
  • Retransplantation
  • Segmental donor graft

ASJC Scopus subject areas

  • Surgery

Cite this

Langham, M. R., Tzakis, A. G., Gonzalez-Peralta, R., Thompson, J. F., Rosen, C. B., Nery, J. R., ... Howard, R. J. (2001). Graft survival in pediatric liver transplantation. Journal of Pediatric Surgery, 36(8), 1205-1209. https://doi.org/10.1053/jpsu.2001.25763

Graft survival in pediatric liver transplantation. / Langham, Max R.; Tzakis, Andreas G.; Gonzalez-Peralta, Regino; Thompson, John F.; Rosen, Charles B.; Nery, Jose R.; Reed, Alan I.; Ruiz, Philip; VanderWerf, Willem J.; Hemming, Alan; Howard, Richard J.

In: Journal of Pediatric Surgery, Vol. 36, No. 8, 2001, p. 1205-1209.

Research output: Contribution to journalArticle

Langham, MR, Tzakis, AG, Gonzalez-Peralta, R, Thompson, JF, Rosen, CB, Nery, JR, Reed, AI, Ruiz, P, VanderWerf, WJ, Hemming, A & Howard, RJ 2001, 'Graft survival in pediatric liver transplantation', Journal of Pediatric Surgery, vol. 36, no. 8, pp. 1205-1209. https://doi.org/10.1053/jpsu.2001.25763
Langham MR, Tzakis AG, Gonzalez-Peralta R, Thompson JF, Rosen CB, Nery JR et al. Graft survival in pediatric liver transplantation. Journal of Pediatric Surgery. 2001;36(8):1205-1209. https://doi.org/10.1053/jpsu.2001.25763
Langham, Max R. ; Tzakis, Andreas G. ; Gonzalez-Peralta, Regino ; Thompson, John F. ; Rosen, Charles B. ; Nery, Jose R. ; Reed, Alan I. ; Ruiz, Philip ; VanderWerf, Willem J. ; Hemming, Alan ; Howard, Richard J. / Graft survival in pediatric liver transplantation. In: Journal of Pediatric Surgery. 2001 ; Vol. 36, No. 8. pp. 1205-1209.
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abstract = "Background/Purpose: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation. Methods: Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12). Results: One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36{\%}) children were less than 1 year of age at time of transplant, and 80 (55{\%}) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4{\%} and 87.1{\%}). Twenty-five (17{\%}) grafts were reduced, 28 (19{\%}) were split, 6 were from living donors (4{\%}), and 88 (60{\%}) were whole organs. One-year graft survival rate was 80{\%} for whole grafts, 71.6{\%} for reduced grafts, and 64.3{\%} for split grafts (P = .06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P < .01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival. Conclusions: The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.",
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AU - Langham, Max R.

AU - Tzakis, Andreas G.

AU - Gonzalez-Peralta, Regino

AU - Thompson, John F.

AU - Rosen, Charles B.

AU - Nery, Jose R.

AU - Reed, Alan I.

AU - Ruiz, Philip

AU - VanderWerf, Willem J.

AU - Hemming, Alan

AU - Howard, Richard J.

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N2 - Background/Purpose: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation. Methods: Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12). Results: One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36%) children were less than 1 year of age at time of transplant, and 80 (55%) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) grafts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P = .06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P < .01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival. Conclusions: The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.

AB - Background/Purpose: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in children currently treated with liver transplantation. Methods: Data were obtained on all patients less than 21 years of age treated with isolated liver transplants performed after January 1, 1996 in an integrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table analysis were used to analyze these data (SAS v 6.12). Results: One hundred twenty-three children received 147 grafts (62 at the University of Florida, 85 at the University of Miami). Fifty-two (36%) children were less than 1 year of age at time of transplant, and 80 (55%) were less than 2 years of age. Patient survival rate was identical in the 2 centers (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) grafts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P = .06). Children who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P < .01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retransplant did not influence graft survival, nor did the type of graft used influence patient survival. Conclusions: The survival rate of children after liver transplantation is excellent independent of graft type. Use of current techniques to split grafts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in children.

KW - Liver transplantation

KW - Retransplantation

KW - Segmental donor graft

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