This article is more than 5 years old. Information may no longer be current.
Pediatric LT recipients show increased odds for survival post-transplant
Click Here to Manage Email Alerts
BARCELONA — Children who underwent liver transplantation lived for 20 years or more post-transplant, according to data presented at the International Liver Congress.
“These results are unique in terms of time of follow-up and homogeneity of the cohort studied. They provide data to inform families and could be used in the future for comparison,” Emmanuel Gonzales, MD, PhD, professor of pediatrics at Université Paris Sud working in the pediatric liver unit of Bicêtre Hospital, INSERM, AP-HP, France, and Josefina Martinelli, of the pediatric liver unit, AP-HP, told Healio.com/Hepatology. “The overall results are encouraging knowing that these diseases were constantly lethal before the era of pediatric liver transplantation.”
Josefina Martinelli
Martinelli and colleagues retrospectively reviewed medical records of 128 consecutive children who underwent cadaveric transplantation between 1988 and 1993 at Bicêtre Hospital in France. The median age at transplant was 2.5 years. Of the patients, 80 had biliary atresia. 47 children underwent whole liver, 77 underwent partial and four underwent split transplantation.
Most of the patients received cyclosporine/steroids as primary immunosuppression post-transplant (n = 123) and five received tacrolimus/steroids. Of the patients who used cyclosporine/steroids, 47 switched to tacrolimus after a mean interval of 10 years post-transplant.
Results showed patient survival rates were 84% at 5 years, 82% at 10 years, 80% at 15 years and 79% at 20 years post-LT. Overall graft survival rates were 73%, 72%, 67% and 65%, respectively.
One hundred of the patients survived 20 years or more post-LT. Among these patients, alanine aminotransferase levels were abnormal in 27 patients, of which five were above two times the upper limit of normal.
Two patients underwent renal transplantation, one is on dialysis and 20 have arterial hypertension. Nineteen patients had BMI above 25 kg/m²; five above 30 kg/m2.
Among patients who received tacrolimus, three have been treated for lymphoproliferative disorders, another three patients developed insulin-dependent diabetes mellitus and two present with food allergy. Five patients have been off therapy for a median of 7 years, beginning 8 to 26 years after transplantation.
Final height z score was within the mean range of the general population. However, 38% of patients did not reach their target height.
“Final height is acceptable for the majority despite steroids use in this cohort,” the researchers said.
The researchers concluded that 20-year survival after pediatric LT can be expected to be close to 80%, chronic kidney disease is a common complication being close to 35% in long-term survivors and liver tests are normal in 60 % of long-term survivors.
“We believe 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,” Gonzales said
In a press release from EASL, Laurent Castera, MD, PhD, EASL secretary-general, 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.” – by Melinda Stevens
Reference:
Martinelli J, et al. Abstract PS038. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.
Disclosure: The researchers report no relevant financial disclosures.