2011 - ISBTS 2011 Symposium


Oral Communications 7: Complications

9.156 - Liver dysfunction following pediatric liver-inclusive intestinal transplantation

Presenter: Robert, Venick, Los Angeles, United States
Authors: Robert Venick1,2, Sue McDiarmid1,2, Laura Wozniak1, Yvonne Esmailian2, Vilayphone Hwang2, Susan Ponthieux2, Ronald Busuttil2, Douglas Farmer2


156
Liver dysfunction following pediatric liver-inclusive intestinal transplantation

Robert Venick1,2, Sue McDiarmid1,2, Laura Wozniak1, Yvonne Esmailian2, Vilayphone Hwang2, Susan Ponthieux2, Ronald Busuttil2, Douglas Farmer2

1Department of Pediatrics, UCLA, Los Angeles, CA, United States; 2Department of Surgery, UCLA, Los Angeles, CA, United States

Background: Intestinal graft function has been well chronicled following combined Liver-inclusive-Intestinal Transplantation (LiITx) .  The aim of this study was to describe in detail liver dysfunction following LiITx.

Methods: We conducted an IRB-approved, retrospective, single-center cohort study of all pediatric LiITx recipients with > 6 mo graft survival. Liver function tests were collected serially post- LiITx. Graft dysfunction was defined as ALT>100 (U/L), or T or D bilirubin >2.0 or > 1.0 (mg/dL) respectively. 20 demographic & clinical variables related to nutrition, surgery, immunosuppression, hospitalization & infection were analyzed using Chi-square methods as potential predictors of graft dysfunction.

Results: Between November 1991- May 2011, 45 children who received 49 LiITx met inclusion criteria. Leading indications for LiITx =gastroschisis (32%) & NEC (18%). Mean age at LiITx =4.2±4.4 yrs, follow-up time= 4.8± 3.7 years, cold & warm ischemia time (C&WIT)= 7.0 ±1.9 & 0.6 ± 0.2 hours, tube feeds were started = 7.5 ± 3.1 days & TPN was weaned off = 34 ± 24 days post- LiITx. Liver function tests are shown in Table 1.  The percentage of patients with liver dysfunction post- LiITx were: Day+7 =76%, Day +30= 31%, Day +180= 9%, Day +365= 7%
Predictors of graft dysfunction at +30 days were: sepsis (p=0.04) & WIT > 60 minutes (p=0.08); predictors at +180 days were: age at LiITx <2 y/o (p=0.05) & >100 hospitalization days (p=0.04).
61 percutaneous liver biopsies were performed during the first year post- LiITx. At the time of biopsy 60% of patients had evidence of liver & intestinal graft dysfunction vs. 40% had liver only dysfunction. 13% (n=8)of biopsies revealed acute cellular rejection (ACR) of the liver graft.

Conclusions: Liver function following pediatric LiITx is excellent. ACR of the liver is relatively uncommon. If it occurs it tends to be in the first 60 days post- LiITx & is associated with sepsis and prolonged WIT.

Table 1 Median liver function tests in year 1 following Liver-inclusive-Intestinal Transplantation (LiITx).

 

ALT (U/L)

T/ D Bilirubin (mg/dL)

Alkaline Phosphatase (U/L)

Albumin (g/dL)

Pre-LiITx

115

15.5/ 8.9

197

2.8

Day +3

148

3.7/ 2.3

72

2.8

Day +7

47

3.0/ 1.4

96

2.7

Day +30

33

1.4/ 0.5

255

2.9

Day +180

21

0.4/ 0.1

179

3.5

Day +365

28

0.2/ 0.1

165

3.3


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