“The success of liver transplantation in children is defined by more than just excellent survival rates. Better understanding of the long-term medical considerations is of critical importance in pediatric liver transplant recipients, who by nature of their young age face a greater cumulative burden of life-long immunosuppression,” Dr. Vicky Lee Ng and co-researchers emphasize in their report in the December issue of Pediatrics.
Liver transplantation has been the standard of care for life-threatening hepatic diseases for more than two decades, yet multicenter data regarding the long-term outcomes has been lacking, Dr. Ng, from the University of Toronto, and colleagues point out.
The current investigation included 461 patients who survived longer than 5 years after undergoing liver transplantation at 1 of 45 pediatric centers across North America from 1996 to 2001.
Overall, 88% of patients survived with their first graft, while 12% required one or two additional grafts.
Most patients had a functional graft at their 5-year clinic assessment, the report indicates. For immunosuppression, a calcineurin inhibitor and prednisone were used by 97% and 25% of subjects, respectively.
The risk of an episode of acute cellular rejection within 5 years was 60%. Chronic rejection was seen in 5% of patients, the authors note.
Six percent of children had posttransplant lymphoproliferative disease. Thirteen percent of subjects had a calculated glomerular filtration rate of < 90 mL/min per 1.73 m². After adjusting for age and gender, 12% of subjects had a body mass index above the 95th percentile and 29% of patients had a height below the 10th percentile.
“This study emphasizes the need for a collaborative partnership between primary care practitioners and pediatric healthcare providers both beyond and within transplant centers to further improve outcomes for pediatric liver transplant recipients,” the researchers conclude.