Outcomes of 5-Year Survivors of Pediatric Liver Transplantation: Report on 461 Children From a North American Multicenter Registry

Although liver transplantation has been the standard of care therapy for life-threatening liver diseases for >20 years, data on the long-term impact of liver transplantation in children have been primarily limited to single-center experiences. The objective of this study was to characterize and e...

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Published in:	Pediatrics (Evanston) 2008-12, Vol.122 (6), p.e1128-e1135
Main Authors:	Ng, Vicky Lee, Fecteau, Annie, Shepherd, Ross, Magee, John, Bucuvalas, John, Alonso, Estella, McDiarmid, Suzanne, Cohen, Geoff, Anand, Ravinder, and Studies of Pediatric Liver Transplantation Research Group
Format:	Article
Language:	eng
Subjects:	Child Child, Preschool Children & youth Clinical medicine Clinical outcomes Female Follow-Up Studies Graft Rejection Graft Survival Humans Immunosuppressive Agents - therapeutic use Infant Kaplan-Meier Estimate Liver Liver Failure - congenital Liver Failure - mortality Liver Failure - surgery Liver Function Tests Liver Transplantation - adverse effects Liver Transplantation - mortality Liver Transplantation - pathology Male North America Pediatrics Pediatrics - standards Pediatrics - trends Probability Registries Statistics, Nonparametric Survivors - statistics & numerical data Time Factors Transplantation, Homologous Transplants & implants
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Summary:	Although liver transplantation has been the standard of care therapy for life-threatening liver diseases for >20 years, data on the long-term impact of liver transplantation in children have been primarily limited to single-center experiences. The objective of this study was to characterize and evaluate the clinical course of children who have survived >or=5 years after pediatric liver transplantation in multiple centers across North America. Patients enrolled in the Studies of Pediatric Liver Transplantation database registry who had undergone liver transplantation at 1 of 45 pediatric centers between 1996 and 2001 and survived >5 years from liver transplantation were identified and their clinical courses retrospectively reviewed. The first graft survival for 461 five-year survivors was 88%, with 55 (12%) and 10 (2%) children undergoing a second and third liver transplantation. At the 5-year anniversary clinic visit, liver function was preserved in the majority with daily use of immunosuppression therapy, including a calcineurin inhibitor and oral prednisone, reported by 97% and 25% of children, respectively. The probability of an episode of acute cellular rejection occurring within 5 years after liver transplantation was 60%. Chronic rejection occurred in 5% patients. Posttransplant lymphoproliferative disease was diagnosed in 6% children. Calculated glomerular filtration rate was 95th percentile was noted in 12%, with height below the 10th percentile in 29%. Children who are 5-year survivors of liver transplantation have good graft function, but chronic medical conditions and posttransplantation complications affect extrahepatic organs. A comprehensive approach to the management of these patients' multiple unique needs requires the expertise and commitment of health care providers both beyond and within transplant centers to further optimize long-term outcomes for pediatric liver transplant recipients.
ISSN:	0031-4005 1098-4275