title: Causes of mortality beyond 1 year after primary pediatric liver transplant under tacrolimus.
abstract: BACKGROUND
  Success of pediatric liver transplantation has improved significantly. Most posttransplant deaths occur early and are related to surgical complications or recipient status at the time of transplantation. The causes of mortality beyond the first year have not been well described.
  
  
  METHODS
  Three hundred twenty-six pediatric liver transplants were performed between November 1989 and April 1998 using tacrolimus-based immunosuppression. Patients were followed until March 2002. Mean follow-up was 9.2+/-2.4 years.
  
  
  RESULTS
  At 1 year, 279 patients (85.5%) were alive. In the subsequent 12.5 years, 10 of the remaining children died (3.58%) at a mean interval of 3.68+/-1.69 years after transplant. The mean age at transplant was 5.62+/-6.3 years. Six patients had infections as a major contributor to mortality, including two patients with posttransplant lymphoproliferative disorder (PTLD) and one patient that died after retransplantation for hepatitis. Two patients had recurrent malignancy. Other deaths were attributable to chronic rejection, liver failure after being lost to follow-up, and complications of cystic fibrosis.
  
  
  CONCLUSIONS
  Pediatric liver transplantation using tacrolimus-based immunosuppression has demonstrated excellent success, with 1- and 10-year survival rates of 85.5% and 82.9%, respectively. Late mortality after pediatric liver transplantation overall remains low, with a rate of 0.32% per year. The most common cause of death was infection (60%), including PTLD-related disease (20%). However, in the recent cohort of patients who underwent transplantation after September 1995, there were no fatal cases of Epstein-Barr virus or PTLD or late mortality thus far, suggesting a benefit from improved infectious disease surveillance using currently available modalities. Mortality from chronic rejection and noncompliance under tacrolimus has been exceedingly rare.
authors.affiliation: Department of Surgery, Children's Hospital of Pittsburgh, and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: Ashok
authors.initials: A
authors.lastname: Jain
authors.forename: Jorge
authors.initials: J
authors.lastname: Reyes
authors.forename: Rebecca
authors.initials: R
authors.lastname: Biederman
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sindhi
authors.forename: George V
authors.initials: GV
authors.lastname: Mazariegos
mesh_terms: D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D007223:Infant; D007239:Infections / Q000401:mortality; D017093:Liver Failure / Q000401:mortality / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality; D016031:Liver Transplantation / Q000401:mortality*; D008232:Lymphoproliferative Disorders / Q000401:mortality; D008297:Male; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus