Outcomes of 5-year survivors of pediatric liver transplantation: report on 461 children from a north american multicenter registry.
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.
Ng
Vicky Lee
VL
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
Fecteau
Annie
A
Shepherd
Ross
R
Magee
John
J
Bucuvalas
John
J
Alonso
Estella
E
McDiarmid
Suzanne
S
Cohen
Geoff
G
Anand
Ravinder
R
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
D007166:Immunosuppressive Agents