Document Detail


Predictors of survival following liver transplantation in infants: a single-center analysis of more than 200 cases.
MedLine Citation:
PMID:  19997060     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Robert S Venick; Douglas G Farmer; Sue V McDiarmid; John P Duffy; Sherilyn A Gordon; Hasan Yersiz; Johnny C Hong; Jorge H Vargas; Marvin E Ament; Ronald W Busuttil
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Transplantation     Volume:  89     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-10     Completed Date:  2010-04-06     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  600-5     Citation Subset:  IM    
Affiliation:
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
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MeSH Terms
Descriptor/Qualifier:
Body Size
Cholestasis / surgery
Cohort Studies
Creatinine* / blood
Decision Making
Ethnic Groups
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Survival / physiology*
Humans
Infant
Liver Failure / surgery
Liver Transplantation / mortality,  physiology*
Male
Predictive Value of Tests
Renal Replacement Therapy / statistics & numerical data
Retrospective Studies
Survival Rate
Time Factors
Grant Support
ID/Acronym/Agency:
L40 DK076289-01/DK/NIDDK NIH HHS; L40 DK076289-02/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
60-27-5/Creatinine
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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