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Good graft function seen in 5-year survivors of pediatric liver transplantation

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – New research indicates that most children who are 5-year survivors of liver transplantation have good graft function; however, chronic medical conditions and complications affecting extrahepatic organs are common in this patient population.

“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. Reference:
Pediatrics 2008;122:e1128-e1135.