Impact of surgical and immunological parameters in pediatric liver transplantation: a multivariate analysis in 500 consecutive recipients of primary grafts.
OBJECTIVE
To assess the respective impact of surgical and immunologic factors on patient/graft outcome and rejection after pediatric liver transplantation.


BACKGROUND
Orthotopic liver transplantation (OLT) constitutes a validated therapeutic modality for acute liver failure and end-stage liver disease in children. Only a few large studies of factors influencing outcome of pediatric OLT are available in the literature. Studies considering the impact of rejection on graft outcome are scarce in adult OLT and are not even available for pediatric recipients.


METHODS
Five hundred consecutive pediatric recipients (<15 years) of a primary OLT performed between March 1984 and July 2000 were retrospectively reviewed. The main indication was biliary atresia (n = 328). A living related donor graft was used from July 1993 onwards in 82 children (16%). Survival was calculated and multivariate analysis was performed.


RESULTS
Actuarial survival rates at 1, 5, and 10 years were 85%, 81%, and 79% for patients, and 76%, 71%, and 70% for grafts, respectively. At the multivariate analysis, only 3 factors were found to be independently correlated with better patient survival: year of transplantation (P = 0.001), pretransplant diagnosis (P < 0.001, worst results for liver tumors), and ABO matching (P < 0.001, worst results for ABO incompatibility). Similarly, 3 factors were independently correlated with better rejection-free graft survival: tacrolimus as primary immunosuppressant (P < 0.001), a negative T-cell crossmatch (P = 0.016), and younger age of the donor (P < 0.001).


CONCLUSIONS
Pediatric OLT constitutes a complex undertaking with multifactorial impact on results: (1). a strong learning curve effect was shown to impact on overall results; (2). pediatric liver tumors still represent a challenging indication for OLT; (3). primary immunoprophylaxis with tacrolimus provided a lower rejection incidence; (4). the younger donor age effect deserves further immunologic investigations.
Evrard
Veerle
V
Pediatric Liver Transplant Program, Saint-Luc University Clinics Université catholique de Louvain, Brussels, Belgium.
Otte
Jean-Bernard
JB
Sokal
Etienne
E
Rochet
Jean-Stéphan
JS
Haccourt
Fabian
F
Gennari
Fabrizio
F
Latinne
Dominique
D
Jamart
Jacques
J
Reding
Raymond
R
D000017:ABO Blood-Group System; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents