title: Outcomes in pediatric hepatitis C transplant recipients: analysis of the UNOS database.
abstract: HCV may lead to the development of ESLD in late childhood and, consequently, contributes to the need for liver transplantation. The aim of this study was to examine post-transplant outcomes in HCV-positive pediatric patients with ESLD from any cause and to determine the impact of the PELD scoring system, introduced in February 2002, on post-transplant patient and graft survival. A retrospective analysis of the UNOS database from 1994 to 2010 was performed to assess graft and patient survival in pediatric HCV-seropositive liver transplant recipients. Graft survival and patient survival comparing subjects in the pre-PELD era and post-PELD era were analyzed using Kaplan-Meier statistics. Factors associated with survival were identified using Cox regression analysis. Of 120 pediatric HCV transplant recipients, 80 were transplanted in the pre-PELD era and 40 were transplanted post-PELD. Median serum total bilirubin, INR, and creatinine were 4.8 mg/dL, 1.6, and 0.7 mg/dL in the pre-PELD era vs. 5.5 mg/dL, 1.7, and 0.6 mg/mL, respectively, in the post-PELD era (p NS). One-yr graft survival in the pre-PELD vs. post-PELD era was 65.0% and 89.7%, respectively (p < 0.01); corresponding three-yr graft survival was 57.3% vs. 76.2% (p = 0.04). One-yr patient survival in the pre-PELD vs. post-PELD era was 79.0% and 97.5%, respectively (p < 0.01); corresponding three-yr survival was 79.0% vs. 89.4% (p = 0.17). Twenty-eight patients (23.3%) were retransplanted: 24 (30%) in the pre-PELD era (median time to retransplant 272 days) and four (10%) in the post-PELD era (median time to retransplant 586 days). Early follow-up demonstrates a trend toward improved pediatric HCV liver transplant graft and patient survival in the post-PELD era. Superior outcomes may be attributed to pretransplant factors, improved surgical technique and better treatment options for HCV infection.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Gupta
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Bahirwani
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Levine
authors.forename: Saloni
authors.initials: S
authors.lastname: Malik
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000601:surgery / Q000628:therapy; D005260:Female; D006085:Graft Survival; D016174:Hepacivirus; D006526:Hepatitis C / Q000601:surgery* / Q000628:therapy; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
chemical_list: D003404:Creatinine; D001663:Bilirubin
keywords: graft; hepatitis C; liver; model for end-stage liver disease; pediatric; pediatric end-stage liver disease; survival