This article is more than 5 years old. Information may no longer be current.
Survival following liver transplant in critically ill children greatly improved
Click Here to Manage Email Alerts
Advances in pediatric critical care have led to significantly improved outcomes of orthotopic liver transplantation, or OLT, for children with liver failure, according to a retrospective study published in Journal of the American College of Surgeons.
The researchers advocate that the survival rates of children and infants with end-stage liver disease and acute liver failure justify the use of a scarce donor allograft.
“As critical care has improved and medical centers can keep seriously ill children alive longer, the question has evolved from can we perform a transplantation to should we do a transplant operation,” John Goss, MD, FACS, professor of surgery, Michael E. DeBakey Department of Surgery and chief of the division of abdominal transplantation at the Baylor College of Medicine, said in a press release. “The answer is yes, we can go ahead and transplant an organ into a critically ill child and expect the same outcome we would see in a stable child. The one caveat is if a medical center does not have the resources to perform a high volume of transplantations then it should transfer critically ill children to a center that does.”
The researchers identified 13,723 pediatric transplant recipients from between Sept. 1, 1987, and June 30, 2015, using the United Network for Organ Sharing and the Organ Procurement and Transplantation Network. They divided the analysis into a remote era (Sept. 1, 1987, to Mar. 1, 2002) and a /Pediatric era (Mar. 1, 2002, to June 30, 2015) due to a significant shift in policy about the use of MELD and PELD scores for liver allocation.
There was significant improvement in 1-year survival after OLT in children in the ICU from 60% in 1987 to 92% in 2013 (P < .001), in children on dialysis from 50% in 1995 to 95% in 2013 (P < .001), in children on mechanical ventilator dependence from 49% in 1994 to 94% in 2013 (P < .001) and in infants younger than 12 months old in the ICU after OLT from 45% in 1988 to 88% in 2013 (P < .001).
The researchers identified significant risk factors that increased the risk for mortality, including previous transplantation, serum sodium over 150 mEq/L, dialysis or glomerular filtration rate, mechanical ventilation dependence, body weight less than 6 kg and annual center volume of less than five cases.
“Irrespective of the definition of critical illness, whether it be dialysis or mechanical ventilator dependence, the outcomes are now comparable with those of the general population,” the researchers wrote. “Although we cannot declare absolutely that no child should be left behind, we can demonstrate acceptable outcomes to date and urge the continual revisiting of our concepts of futility.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts