Abstract
Introduction: While end-stage liver disease from Hepatitis C Virus (HCV) is the leading indication for orthotopic liver transplantation (OLT) for adults in the US, it rarely leads to transplantation in children. Furthermore, HCV infection in the pediatric population follows a unique course. Very little data exists, however, regarding liver transplantation for children with HCV Aims: 1) Compare graft and patient survival in pediatric versus adult HCV transplant recipients. 2) Determine the impact of re-transplantation for recurrent disease on patient and graft survival in children. 3) Identify independent risk factors associated with worsened graft and patient survival in the pediatric HCV liver transplant recipients. Methods: The United Network for Organ Sharing (UNOS) database of liver transplant recipients from September 30, 1987 through February 20, 2009 was queried. Patients receiving OLT for HCV associated liver disease (acute hepatic failure and cirrhosis) were selected. Patients with any comorbid liver disease were excluded. Children in this group were defined as 21 or younger at transplant. Graft and patient survival were calculated via the Kaplan-Meier method, with comparison between groups made by log-rank test. The relative impact of risk factors on graft and patient survival were calculated using a Cox Regression model. All statistical computations were performed with SPSS version 15.0 (Chicago, Illinois). Results: A total of 18,961 first-time OLT's were performed for HCV-associated liver disease (94 pediatric, 18,867 adult). Of these, 941 patients were re-transplanted for recurrence: 18 children (19.1%) vs. 923 adults (4.9%). Children experienced significantly shorter graft survival after first transplant in comparison to adults (2792 days vs. 3346 days mean survival, p=0.045). Mean patient survival was, however, similar between the two groups after first transplant (4196 vs 3816 days, p=0.468). Re-transplantation did not adversely impact graft or patient survival in the pediatric HCV recipients. Mean graft survival was 2792, 1873, and 1500 days, after first, second, and third transplants, respectively (p=0.847-0.996). Mean patient survival was 4196, 1982, and 1499 days after first, second, and third time transplants (p=0.197-0.921). No independent risk factors for worsened patient or graft survival were identified by Cox regression. Conclusions: While pediatric OLT recipients with HCV have worsened graft survival in comparison to their adult counterparts, patient survival is similar. Furthermore, re-transplantation for recurrent disease in children is a safe option not associated with worsened graft or patient survival. Further study is necessary to identify risk factors for OLT in this population.
Published Version
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