Graft loss after pediatric liver transplantation.
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.
Sieders
Egbert
E
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.
Peeters
Paul M J G
PM
TenVergert
Elisabeth M
EM
de Jong
Koert P
KP
Porte
Robert J
RJ
Zwaveling
Jan H
JH
Bijleveld
Charles M A
CM
Gouw
Annette S H
AS
Slooff
Maarten J H
MJ
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