title: Outcomes of 5-year survivors of pediatric liver transplantation: report on 461 children from a north american multicenter registry.
abstract: OBJECTIVE
  Although liver transplantation has been the standard of care therapy for life-threatening liver diseases for >20 years, data on the long-term impact of liver transplantation in children have been primarily limited to single-center experiences. The objective of this study was to characterize and evaluate the clinical course of children who have survived >or=5 years after pediatric liver transplantation in multiple centers across North America.
  
  
  METHODS
  Patients enrolled in the Studies of Pediatric Liver Transplantation database registry who had undergone liver transplantation at 1 of 45 pediatric centers between 1996 and 2001 and survived >5 years from liver transplantation were identified and their clinical courses retrospectively reviewed.
  
  
  RESULTS
  The first graft survival for 461 five-year survivors was 88%, with 55 (12%) and 10 (2%) children undergoing a second and third liver transplantation. At the 5-year anniversary clinic visit, liver function was preserved in the majority with daily use of immunosuppression therapy, including a calcineurin inhibitor and oral prednisone, reported by 97% and 25% of children, respectively. The probability of an episode of acute cellular rejection occurring within 5 years after liver transplantation was 60%. Chronic rejection occurred in 5% patients. Posttransplant lymphoproliferative disease was diagnosed in 6% children. Calculated glomerular filtration rate was <90 mL/minute per 1.73 m2 in 13% of 5-year survivors. Age- and gender-adjusted BMI>95th percentile was noted in 12%, with height below the 10th percentile in 29%.
  
  
  CONCLUSIONS
  Children who are 5-year survivors of liver transplantation have good graft function, but chronic medical conditions and posttransplantation complications affect extrahepatic organs. A comprehensive approach to the management of these patients' multiple unique needs requires the expertise and commitment of health care providers both beyond and within transplant centers to further optimize long-term outcomes for pediatric liver transplant recipients.
authors.affiliation: SickKids Transplant Center, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. vicky.ng@sickkids.ca
authors.forename: Vicky Lee
authors.initials: VL
authors.lastname: Ng
authors.forename: Annie
authors.initials: A
authors.lastname: Fecteau
authors.forename: Ross
authors.initials: R
authors.lastname: Shepherd
authors.forename: John
authors.initials: J
authors.lastname: Magee
authors.forename: John
authors.initials: J
authors.lastname: Bucuvalas
authors.forename: Estella
authors.initials: E
authors.lastname: Alonso
authors.forename: Suzanne
authors.initials: S
authors.lastname: McDiarmid
authors.forename: Geoff
authors.initials: G
authors.lastname: Cohen
authors.forename: Ravinder
authors.initials: R
authors.lastname: Anand
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000473:pathology; D008297:Male; D009656:North America; D010372:Pediatrics / Q000592:standards / Q000639:trends; D011336:Probability; D012042:Registries; D018709:Statistics, Nonparametric; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents