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Ann Surg. 2002 Jan;235(1):125-32.

Graft loss after pediatric liver transplantation.

Author information

1
Liver Transplant Group of the University Hospital Groningen, Department of Surgery, Office for Medical Technology Assessment, Pediatrics, and Pathology and Laboratory Medicine, Groningen, The Netherlands.

Abstract

OBJECTIVE:

To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors.

SUMMARY BACKGROUND DATA:

Graft failure after transplantation remains an important problem. It results in patient death or retransplantation, resulting in lower survival rates.

METHODS:

A series of 157 transplantations in 120 children was analyzed. Graft loss was categorized as early (within 1 month) and late (after 1 month). Risk factors were identified by analyzing recipient, donor, and transplantation variables.

RESULTS:

Kaplan-Meier 1-month and 1-, 3-, and 5-year patient survival rates were 85%, 82%, 77%, and 71%, respectively. Graft survival rates were 71%, 64%, 59%, and 53%, respectively. Seventy-one of 157 grafts (45%) were lost: 18 (25%) by death of patients with functioning grafts and 53 (75%) by graft-related complications. Forty-five grafts (63%) were lost early after transplantation. Main causes of early loss were vascular complications, primary nonfunction, and patient death. Main cause of late graft loss was fibrosis/cirrhosis, mainly as a result of biliary complications or unknown causes. Child-Pugh score, anhepatic phase, and urgent transplantation were risk factors for early loss. Donor age, donor/recipient weight ratio, blood loss, and technical-variant liver grafts were risk factors for late loss.

CONCLUSIONS:

To prevent graft loss after pediatric liver transplantation, potential recipients should be referred early so they can be transplanted in an earlier phase of their disease. Technical-variant liver grafts are risk factors for graft survival. The logistics of the operation need to be optimized to minimize the length of the anhepatic phase.

PMID:
11753051
PMCID:
PMC1422404
[Indexed for MEDLINE]
Free PMC Article

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