Jain, A and Mazariegos, G and Kashyap, R and Kosmach-Park, B and Starzl, TE and Fung, J and Reyes, J
(2002)
Pediatric liver transplantation: A single center experience spanning 20 years.
Transplantation, 73 (6).
941 - 947.
ISSN 0041-1337
Abstract
Background. Survival after liver transplantation has improved significantly over the last decade with pediatric recipients faring better than adults. The 20-year experience of pediatric liver transplantation at Children's Hospital of Pittsburgh is reported in terms of patient survival; graft survival in relation to age, gender, and immunosuppressive protocols; causes of death; and indications for retransplantation. Method. From March 1981 to April 1998, 808 children received liver transplants at Children's Hospital of Pittsburgh. All patients were followed until March 2001, with a mean follow-up of 12.2±3.9 years (median= 12.6; range=2.9-20). There were 405 female (50.2%) and 403 male (49.8%) pediatric recipients. Mean age at transplant was 5.3±4.9 years (mean=3.3; range 0.04-17.95), with 285 children (25.3%) being less than 2 years of age at transplant. Cyclosporine (CsA)-based immunosuppression was used before November 1989 in 482 children (50.7%), and the subsequent 326 recipients (40.3%) were treated with tacrolimus-based immunosuppression. Actuarial survival was calculated using the Kaplan-Meier statistical method. Differences in survival were calculated by log-rank analysis. Results. Overall patient survival at 1, 5, 10, 15 and 20 years was 77.1%, 72.6%, 69.4%, 65.8% and 64.4%, respectively. There was no difference in survival for male or female patients at any time point. At up to 10 years posttransplant, the survival for children greater than 2 years of age (79.5%, 75.7%, and 71.6% at 1, 5, and 10 years, respectively) was slightly higher than those at less than 2 years of age (72.6%, 66.9%, and 65.3% at 1, 5, and 10 years, respectively). However, at 15 and 20 years posttransplant, survival rates were similar (>2 years=67.3% and 65.8%; <2 years=64.1% and 64.1%). A significant difference in survival was seen in CsA-based immunosuppression (71.2%, 68.1%, 65.4%, and 61%) versus tacrolimus-based immunosuppression (85.8%, 84.7%, 83.3%, and 82.9%) at 1, 3, 5, and 10 years, respectively (P=0.0001). The maximum difference in survival was noted in the first 3 months between CsA and tacrolimus; thus, indicating there may have been other factors (nonimmunological factors) involved in terms of donor and recipient selection and technical issues. The mean annual death rate beyond 2 years posttransplant was 0.47%, with the mean annual death rate for patients who received tacrolimus-based immunosuppression being significantly lower than those who received CsA-based immunosuppression (0.14% vs. 0.8%; P=0.001). The most common etiologies of graft loss were hepatic artery thrombosis (33.4%), acute or chronic rejection (26.6%), and primary nonfunction (16.7%). Of note, retransplantation for graft loss because of acute or chronic rejection occurred only in those patients who received CsA-based immunosuppression. Conclusion. The overall 20-year actuarial survival for pediatric liver transplantation is 64%. Survival has increased by 20% in the last 12 years with tacrolimus-based immunosuppression. although this improvement may be the result of several factors, retransplantation as a result of acute or chronic rejection has been completely eliminated in patient treated with tacrolimus.
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Details
| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Jain, A | | | | | Mazariegos, G | | | | | Kashyap, R | | | | | Kosmach-Park, B | | | | | Starzl, TE | tes11@pitt.edu | TES11 | | | Fung, J | | | | | Reyes, J | | | |
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| Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
| Date: |
27 March 2002 |
| Date Type: |
Publication |
| Journal or Publication Title: |
Transplantation |
| Volume: |
73 |
| Number: |
6 |
| Page Range: |
941 - 947 |
| DOI or Unique Handle: |
10.1097/00007890-200203270-00020 |
| Institution: |
University of Pittsburgh |
| Refereed: |
Yes |
| ISSN: |
0041-1337 |
| Other ID: |
uls-drl:31735062120781, Starzl CV No. 2170 |
| Date Deposited: |
08 Apr 2010 17:37 |
| Last Modified: |
02 Feb 2019 13:56 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/5556 |
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