Improved outcomes in pediatric liver transplantation for acute liver failure.
OLT is a life-saving option for ALF.


OBJECTIVE
To evaluate our outcomes in pediatric OLT for ALF.


METHODS
Retrospective review of our data between 1992 and 2007.


RESULTS
Of 142 children with ALF, 126 were listed, of which 40 spontaneously improved, nine died, and 77 underwent OLT (median waiting time four days). Fifty-three children received deceased donor grafts (34 whole and 19 split grafts), and there were 24 living donor grafts. The one- and five-yr patient survival was 87% and 80%, and graft survival 83% and 79%, respectively. Thirteen patients died after OLT, and there were nine retransplants in seven patients. Patient weight, length of stay, creatinine, and infection were significantly associated with death; increased weight and black ethnicity were associated with graft loss on univariate analysis, but not on multivariate analysis. There were no significant differences in patient survival (one and five yr), graft loss, or other complications between the groups.


CONCLUSIONS
We report the largest single-center study of OLT in pediatric ALF, demonstrating no difference in outcomes between different graft types. Our liberal use of segmental grafts may allow earlier OLT in this high-risk cohort and contribute to our excellent outcomes.
Miloh
Tamir
T
Department of Pediatrics and Recanati Miller Transplant Institute, Department of Surgery, Mount Sinai Hospital, New York, NY, USA. tamir.miloh@mountsinai.org
Kerkar
Nanda
N
Parkar
Sanobar
S
Emre
Sukru
S
Annunziato
Rachel
R
Mendez
Carlos
C
Arnon
Ronen
R
Suchy
Frederick
F
Rodriguez-Laiz
Gonzalo
G
Del Rio Martin
Juan
J
Sturdevant
Mark
M
Iyer
Kishore
K
D058186:Acute Kidney Injury / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D010372:Pediatrics / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult