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.