title: Incidence and risk factors for the development of prolonged severe intrahepatic cholestasis after pediatric living-donor liver transplantation.
abstract: The aim of this study is to evaluate the incidence, etiology, and risk facrors for prolonged severe intrahepatic cholestasis (PSIC) after 129 pediatric living-donor liver transplantations (LDLT). The incidence of PSIC was 25.6% (n = 33). Twenty-eight (84.8%) versus 5 (15.2%) children experienced early versus late PSIC, respectively. Among these 33 children with PSIC, 8 (24.2%) received a donor liver with mild to moderate fatty change, 4 (12.1%) with low graft-body weight ratios, and 4 (12.1%) with ABO incompatibility. The predominant etiologies were acute rejection (n = 15; 45.5%), chronic rejection (n = 6; 18.2%), virus (n = 3; 9.1%), vascular complications (n = 4; 12.1%), and initial graft dysfunction (n = 10; 30.3%). ABO incompatibility (P = .032; odds ratio [OR] 3.25), chronic rejection (P = .012; OR 4.76), and vascular complications (P = .046; OR 1.82) were significant variables associated with PSIC. Donor selection with ABO compatibility as well as early detection and management of chronic rejection and vascular complications may be important to prevet PSIC in LDLT.
authors.affiliation: Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Oh
authors.forename: K M
authors.initials: KM
authors.lastname: Kim
authors.forename: D Y
authors.initials: DY
authors.lastname: Kim
authors.forename: T
authors.initials: T
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: K-M
authors.initials: KM
authors.lastname: Park
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Lee
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D001787:Blood Group Incompatibility / Q000150:complications / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D046148:Donor Selection; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D019520:Living Donors; D016015:Logistic Models; D016017:Odds Ratio; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology
chemical_list: D000017:ABO Blood-Group System