Risk factors associated with long-term outcomes after pediatric liver transplantation
10.3760/cma.j.cn421203-20230811-00048
- VernacularTitle:儿童肝移植受者术后的长期存活及其影响因素分析
- Author:
Yuan LIU
1
;
Bingran WANG
;
Mingxuan FENG
;
Tao ZHOU
;
Yi LUO
;
Qiang XIA
Author Information
1. 上海交通大学医学院附属仁济医院肝脏外科，上海 200127
- Keywords:
Liver transplantation;
Child;
Pediatric liver transplantation;
Long-term outcome;
Risk factor;
Infection
- From:
Chinese Journal of Organ Transplantation
2024;45(5):308-314
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the overall efficacy of pediatric liver transplantation (LT) and the risk factors affecting the long-term outcomes.Methods:From October 2006 to December 2022, clinical profiles, intraoperative findings, perioperative managements and long-term follow-ups were retrospectively reviewed for 3004 cases (including 40 cases of retransplantation) of children with end-stage liver disease undergoing LT. Overall patient and graft survival rates after transplantation were explored by Kaplan-Meier survival curve. The survival rates of recipients receiving living donor liver transplantation and deceased donor liver transplantation, recipients with body weight ≤5 kg and >5 kg at the time of transplantation, recipients with age ≤5 months and >5 months, graft recipient weight ratio (GRWR) ≤5% and >5 %, and recipients with compatible and incompatible blood types were compared, as well as the survival rates of recipients from 2006 to 2011, 2012 to 2017, and 2018 to 2022. The occurrence of complications was analyzed. Cox regression was used to analyze the risk factors of long-term mortality, and those with <0.05 were included in the LASSO regression model to identify the independent risk factors.Results:As of December 2022, overall survivals at 1/5/10-year were 95.1 %(2 819/2 964), 93.1 % (2 759/2 964) and 91.8% (2 721/2 964) and 1/5/10-year graft survival rate 94.5 % (2 839/3 004), 92.0 % (2 764/3 004) and 86.2 % (2 589/3 004 ). The 5-year survival rate improved : Five-year survival rate at pediatric LT centers were 71.6 % (63/88, from 2006 to 2011), 91.6 % (1 009/1 101 ,from 2012 to 2017) and 95.5 % (1 695/1 775, from 2018 to 2022 ). Survival rates were lower in recipients with body weight ≤5 kg [83.7 % (41 /49) vs 94.4 % (2 746/2 915), P=0.001) ] and GRWR >5 % [90.0 % (378/420) vs 94.6 % (2 046/2 544), P=0.007 ] compared to those >5 kg and ≤5 %. Difference in surgical age and blood type compatibility were not statistically ( P=0.26 and 0.4 ). Infection [35.3 % (70/198) ]and surgical complications [24.2 % (48/198) ]were the main causes of mortality after transplantation. While infection [35.7% (25/70) ] ,portal vein complications [18.6%(13/70) ]and lung injury [15.7 % (11/70) ]were the main reasons of death within 1 month after transplantation. The incidence of postoperative infection and acute rejection decreased from 86.5 %(76/88) and 38.2% (34/88) in 2006-2011 to 75.5% (1 340/1 775) and 22.2% (394/1 775). Post-transplantation surgery-related complications included portal veinous complications (3.1 %, 92/3 004), hemorrhage (2.3 %, 68/3 004) ,hepatic arterial complications (1.7 %, 50/3 004) and hepatic venous complications (1.1 %, 33/3 004). Univariate analysis revealed that risk factors related to postoperative mortality included preoperative anemia ( P=0.012), high preoperative leucocyte count ( P=0.026), preoperative renal insufficiency ( P=0.008), hypoproteinemia ( P=0.001), coagulation dysfunction ( P= 0.005), low body weight ( P=0.007), GRWR>5% ( P=0.001), intraoperative volume of blood loss and transfusion ( P<0.001) ,postoperative intensive care unit (ICU) time ( P<0.001), hospital length post-LT ( P=0.045) ,postoperative lung infection ( P<0.001), abdominal infection ( P=0.029), postoperative hemorrhage ( P<0.001), intestinal perforation ( P<0.001), acute rejection ( P<0.001) Epstein-Barr virus (EBV) infection ( P<0.001) and post-transplant lymphoproliferative disorder (PTLD) ( P=0.018). Multivariable analysis revealed that preoperative creatinine ( HR=1.015, 95% CI: 1.002-1.028, P=0.024), GRWR ( HR=2.082, 95% CI: 0.473-9.157, P=0.031) ,pulmonary infection ( HR=4.389, 95% CI: 2.248-8.569, P<0.001) ,postoperative abdominal hemorrhage ( HR= 6.922, 95% CI:1.871-25.610, P=0.004), intestinal perforation ( HR=9.154, 95% CI: 2.307-36.323, P=0.002) and acute rejection ( HR=0.452, 95% CI: 0.210-0.971, P=0.042) were important influencing factors of long-term survival post-LT. Conclusions:LT is currently the most effective treatment for end-stage liver disease in children. Improving preoperative organ function, optimizing surgical techniques, minimizing intraoperative hemorrhage and preventing postoperative complications can effectively enhance the long-term outcomes of LT recipients.
