title: Liver transplantation in children weighing 5 kg or less: analysis of the UNOS database.
abstract: LT is a major medical and surgical challenge in very small patients. Aim of the study is to determine the outcomes after LT in infants ≤ 5 kg at transplant in a large cohort of patients.
  
  
  METHODS
  Infants ≤ 5 kg who had LT between 10/1987 and 5/2008 were identified from the UNOS database. Risk factors for death and graft loss were analyzed by multivariate logistic regression.
  
  
  RESULTS
  Of 11,467 children, 570 (5%) were ≤ 5 kg at LT. Mean age and weight at LT were 0.11 ± 0.48 yr, 4.32 ± 0.74 kg, respectively. One- and five-yr patient and graft survival were 77.7%, 72.2% and 66.1%, 57.6%, respectively. The primary cause of death was infection (25.9%). Recipient age was a predictor of graft loss. Patient and graft survival have improved over time. Life support at transplant was identified as a risk factor for both death and graft loss (p < 0.02, p < 0.01, respectively).
  
  
  CONCLUSIONS
  LT recipients ≤5 kg have high mortality and graft loss. Over time, graft survival has improved, although it is still inferior to the overall reported outcomes of pediatric LT. Being on life support at transplant is a significant risk factor for death and graft loss in very small recipients.
authors.affiliation: Department of Pediatrics, Mount Sinai School of Medicine, Mount Sinai Medical Center, NY, USA. ronen.arnon@mountsinai.org
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Rachel
authors.initials: R
authors.lastname: Annunziato
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sogawa
authors.forename: Kelsey Van
authors.initials: KV
authors.lastname: Nostrand
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Frederick
authors.initials: F
authors.lastname: Suchy
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
mesh_terms: D001835:Body Weight; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D015233:Models, Statistical; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors