Outcome of liver retransplantation in children.
Irreversible liver graft failure is a life-threatening complication. We reviewed the first 200 pediatric liver transplantations in Birmingham. Forty-one children developed primary graft failure, 9 of whom developed secondary graft failure. The main indications for graft failure were primary nonfunction (PRNF; 8 patients), vascular complications (VASC; 23 patients), and chronic rejection (CHRE; 19 patients). Thirty-two children underwent retransplantation (ReTx) (21 children received reduced grafts; 11 children, whole hepatic grafts). Patient survival was significantly worse for retransplant recipients compared with children receiving a single graft (63% v 76. 5% actuarial patient survival at 1 year; P <.05). Primary graft 1-year actuarial survival was 74% in first grafts compared with 47% for regrafts (P <.05), but improved with time. The graft 1-year survival rate was 55% for whole grafts and 45% for reduced and/or split grafts in the first 100 grafts compared with 83% and 66% in the second 100 grafts, respectively (P <.01). Emergency ReTx within a month of transplantation was associated with more complications and a worse outcome (1-year survival rate, 37%) compared with patients who underwent ReTx later (1-year survival rate, 72%; P <. 01). The incidence of primary graft failure decreased from 33% in the first 100 grafts to 16% in the second 100 grafts (P <.01), as did the incidence of PRNF, which decreased from 8% to 0% (P <.05). Although the rates of graft failure from VASC decreased from 15% to 8% (P =.2) and CHRE decreased from 11% to 8% (P =.6), neither reached statistical significance. The improved results overall are because of advances in surgical techniques, intensive care management, and graft preservation and refinements in immunosuppression. We conclude that ReTx for a child with primary graft failure is justified.
Achilleos
O A
OA
Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Children's Hospital, Birmingham, UK.
Mirza
D F
DF
Talbot
D
D
McKiernan
P
P
Beath
S V
SV
Gunson
B K
BK
Freeman
J W
JW
Mayer
A D
AD
McMaster
P
P
Buckels
J A
JA
Kelly
D A
DA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome