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Pediatric liver transplant patients have good long-term survival
Last Updated: 2016-04-22
By Megan Brooks
NEW YORK (Reuters Health) - Twenty-year survival after pediatric liver transplantation (LT) can be expected to be close to 80%, according to a new study.
"Until now there has been no good answer as to how long children could be expected to live after liver transplantation," lead author Dr. Josefina Martinelli said in a news release from the International Liver Congress 2016 in Barcelona, Spain, sponsored by the European Association for the Study of the Liver (EASL), where the results were presented April 14.
"While each child receiving a transplant is unique and every procedure is different, this study provides robust evidence on the average expected survival rates, an important consideration for the parents of children who undergo this complicated procedure," added Dr. Martinelli, from the Pediatric Liver Unit, APHP-Bicetre Hospital, Paris, France.
The investigators took a look back at the medical records of 128 consecutive children who underwent cadaveric LT (47 whole liver, 77 partial liver and four split liver) at their center from 1988 to 1993. The children had a median age of 2.5 years at LT and were followed for an average of up 22 years.
Patient survival rates at five, 10, 15, and 20 years post-LT were 84%, 82%, 80%, and 79%, respectively, and graft survival rates were 73%, 72%, 67%, and 65%.
The most common complication was infection (59%), which isn't surprising, Dr. Martinelli told Reuters Health. "Infections, bacterial in particular, are among the most frequent early complications. Poor nutritional status prior to transplantation, surgical opening of the gut, catheters, surgical drains, biliary complications, and tracheal tubes all favor bacterial infection."
"In addition, viral primoinfections are frequent in these very young patients who are seronegative for most viruses. Both bacterial and viral infections are particularly severe in this context because during the early posttransplant period the immunosuppression is very strong to prevent early rejection of the liver graft," Dr. Martinelli explained in email.
The second most common complications were acute (44%) and chronic (37%) rejection. "Chronic kidney disease is a common complication being close to 35% in long-term survivors. Liver tests are normal in 60% of long-term survivors and final height is acceptable for the majority despite steroids use in this cohort," Dr. Martinelli said.
"This study is evidence of the great progress the medical community is making as we continue to learn more about how the body deals with transplanted organs," Professor Laurent Castera, EASL secretary general, said in the release.
"We believe," Dr. Martinelli told Reuters Health, "that early post-transplant mortality could be decreased: living-related liver transplantation, improvement of pre-transplantation care (nutritional support, early Kasai procedure). New combined immunosuppressive regimens may lower renal drug toxicity, less or no steroids may improve growth."
International Liver Congress 2016.