Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases.
BACKGROUND
Infants (<12 months) who require liver transplantation (LTx) represent a particularly challenging and understudied group of patients.


METHODS
This retrospective study aimed to describe a large single-center experience of infants who received isolated LTx, illustrate important differences in infants versus older children, and identify pretransplant factors which influence survival. More than 25 pre-LTx demographic, laboratory, and operative variables were analyzed using the Log-rank test and Cox proportional hazards model.


RESULTS
Between 1984 and 2006, 216 LTx were performed in 186 infants with a mean follow-up time of 62 months. Median age at LTx was 9 months, the majority had cholestatic liver disease, were hospitalized pre-LTx, and received whole grafts. Leading indications for re-LTx (n=30) included vascular complications (43%) and graft nonfunction (40%), whereas leading causes of death were sepsis and multiorgan failure. One-, 5-, and 10-year graft and patient survivals were 75%/72%/68% and 79%/77%/75%, respectively. Relative to older pediatric recipients, infants had worse overall patient survival (P=0.05). The following were significant univariate predictors of graft loss: age less than 6 months and reduced cadaveric grafts; and of patient loss: age less than 6 months, calculated CrCl less than 90, pre-LTx hospitalization, pre-LTx mechanical ventilation, repeat LTx, infants transplanted for reasons other than cholestatic liver disease, and patients transplanted between 1984 and 1994.


CONCLUSIONS
Long-term outcomes for infants undergoing LTx are excellent and have improved over time. As the largest, single-center analysis of LTx in infants, this study elucidates a unique set of predictors that can aid in medical decision making.
Venick
Robert S
RS
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA, PO Box 91752, Los Angeles, CA 90095-1752, USA. Rvenick@mednet.ucla.edu
Farmer
Douglas G
DG
McDiarmid
Sue V
SV
Duffy
John P
JP
Gordon
Sherilyn A
SA
Yersiz
Hasan
H
Hong
Johnny C
JC
Vargas
Jorge H
JH
Ament
Marvin E
ME
Busuttil
Ronald W
RW
D049628:Body Size; D002779:Cholestasis / Q000601:surgery; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D011237:Predictive Value of Tests; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
D003404:Creatinine