title: Graft loss after pediatric liver transplantation.
abstract: OBJECTIVE
  To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors.
  
  
  BACKGROUND
  Graft failure after transplantation remains an important problem. It results in patient death or retransplantation, resulting in lower survival rates.
  
  
  METHODS
  A series of 157 transplantations in 120 children was analyzed. Graft loss was categorized as early (within 1 month) and late (after 1 month). Risk factors were identified by analyzing recipient, donor, and transplantation variables.
  
  
  RESULTS
  Kaplan-Meier 1-month and 1-, 3-, and 5-year patient survival rates were 85%, 82%, 77%, and 71%, respectively. Graft survival rates were 71%, 64%, 59%, and 53%, respectively. Seventy-one of 157 grafts (45%) were lost: 18 (25%) by death of patients with functioning grafts and 53 (75%) by graft-related complications. Forty-five grafts (63%) were lost early after transplantation. Main causes of early loss were vascular complications, primary nonfunction, and patient death. Main cause of late graft loss was fibrosis/cirrhosis, mainly as a result of biliary complications or unknown causes. Child-Pugh score, anhepatic phase, and urgent transplantation were risk factors for early loss. Donor age, donor/recipient weight ratio, blood loss, and technical-variant liver grafts were risk factors for late loss.
  
  
  CONCLUSIONS
  To prevent graft loss after pediatric liver transplantation, potential recipients should be referred early so they can be transplanted in an earlier phase of their disease. Technical-variant liver grafts are risk factors for graft survival. The logistics of the operation need to be optimized to minimize the length of the anhepatic phase.
authors.affiliation: Liver Transplant Group of the University Hospital Groningen, Department of Surgery, Office for Medical Technology Assessment, Pediatrics, and Pathology and Laboratory Medicine, Groningen, The Netherlands.
authors.forename: Egbert
authors.initials: E
authors.lastname: Sieders
authors.forename: Paul M J G
authors.initials: PM
authors.lastname: Peeters
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: TenVergert
authors.forename: Koert P
authors.initials: KP
authors.lastname: de Jong
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.forename: Jan H
authors.initials: JH
authors.lastname: Zwaveling
authors.forename: Charles M A
authors.initials: CM
authors.lastname: Bijleveld
authors.forename: Annette S H
authors.initials: AS
authors.lastname: Gouw
authors.forename: Maarten J H
authors.initials: MJ
authors.lastname: Slooff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D009102:Multiple Organ Failure / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors