Abstract
(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.
Highlights
Most of the previously discovered risk factors are given and not to be modified; our aim was to identify ideally modifiable recipient-specific risk factors for impaired graft and patient survival in order to create the optimal, baseline conditions for patient and graft survival
Patient survival is comparable to pediatric liver transplantation cohorts in other experienced centers, the one- and 5-year patient survival of 97.5% in the most recent era is slightly higher when compared to the recently published reports of the North American SPLIT registry [19], documenting a similar time span, whereas 5-yeargraft survival is slightly lower when compared to the data from North America
Our analysis of independent recipient-specific risk factors for patient and graft survival after pediatric liver transplantation has supported the results of previous analyses, and led to new findings
Summary
Most of the previously discovered risk factors are given and not to be modified; our aim was to identify ideally modifiable recipient-specific risk factors for impaired graft and patient survival in order to create the optimal, baseline conditions for patient and graft survival. This is the first study to describe the long-term outcome of our pediatric liver transplant cohort and the largest European single-center pediatric liver transplant cohort described so far. The first liver transplantation was performed at Hannover Medical School in 1972, the first pediatric liver transplant in 1979 and a regular pediatric liver transplant program was set up in 1983. We aimed to detect changes over time, regarding indications and outcome of pLTx recipients
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