2016 - IPTA Fellows Meeting
Mini-Oral Abstract Presentations
14.40 - Pediatric liver transplantation - an outcome analysis of a 30-year single centre experience
Presenter: Annemarie, Weissenbacher, Innsbruck, Austria
Authors: Annemarie Weissenbacher, Tim Pascal Schebesta, Christian Margeiter, Rupert Oberhuber, Benno Cardini, Johanna Grahammer, Thomas Mueller, Dietmar Oefner, Stefan Schneeberger
Pediatric liver transplantation - an outcome analysis of a 30-year single centre experience
Annemarie Weissenbacher1,3, Tim Pascal Schebesta1, Christian Margeiter1, Rupert Oberhuber1, Benno Cardini1, Johanna Grahammer1, Thomas Mueller2, Dietmar Oefner1, Stefan Schneeberger1.
1Innsbruck University Hospital, Department of Surgery, Visceral, Transplant and Thoracic Surgery, Innsbruck, Austria; 2Innsbruck University Hospital , Department of Paediatrics I, Innsbruck, Austria; 3Oxford University, Nuffield Department of Surgical Sciences, Oxford Transplant Centre , Oxford, United Kingdom
Introduction: In this study we aim to assess factors influencing long-term patient and graft survival as well as surgical parameters and risk factors influencing organ function after paediatric liver transplantation.
Patients and Methods: We performed a retrospective analysis of 110 consecutive paediatric liver transplantations (LTx) between 1984 and 2014 at Innsbruck Medical University. Kaplan-Meier and log-rank analyses were performed to assess 5- and 10-year patient and graft survival. The Cox proportional hazards model was used to determine predictors of outcome.
Results: A total of 55 deceased donor LTx, 14 deceased donor split-LTx, 38 LTx from living donors and 3 multivisceral transplantations performed in children between 3 months and 17 years were included in this study. The median follow-up is 9.13 years. Fourteen LTx were retransplantations. Median recipient age was 2.94 (0.31-16.93) years, median donor age was 24 (1-59) years. The mean anhepatic period was 55.6 ± 20.2 min, and the mean cold ischemia time (CIT) was 6 ± 4.01 hours. After an initial 5-year patient and graft survival rate of 61.4% and 52.1% in the era between 1984 and 1994, the long-term increased to 88.3% and 90.5% graft and patient survival after 5 and 10 years (p=0.0008 and 0.0003) in the era from 2005 to 2014. Five and 10-year patient and graft survival after living-LTx were 97.3% and 94.5%.
Graft type, liver disease, donor or recipient age had no significant impact on long-term graft survival. Duration of the anhepatic period did not impact patient (p=0.439) and graft survival (p=0.354). A CIT longer than 6 hours, however, resulted in a significant lower patient (p=0.007) and graft (0.019) survival. In the deceased donor subgroup, recipients younger than 5 years had a significant worse 5- and 10-year-outcome (69.6% and 61.9% vs. 88.6% and 83.9% patient survival, p=0.020; 63.2% and 55.3% vs. 85.7% and 81% graft survival, p=0.024). Of all the laboratory parameters we analysed, the course of serum bilirubin showed significant impact on graft and patient survival.
Conclusion: Excellent long-term results could be achieved with liver transplantation in children during the last 30 years. Limited ischemia time, detailed surgical planning and close long-term monitoring are factors influencing the outcome.
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