Despite liver transplantation being the treatment of choice amongst children with end-stage liver disease, a considerable number of children still die after the procedure.
A team from Groningen, The Netherlands analyzed the long-term actual survival rates for children after orthotopic liver transplantation, and identified prognostic factors for survival.
Actual survival rates:
66 children receiving transplants, who had or could have had a follow-up of at least 5 years, were analyzed retrospectively. Actual survival and prognostic factors in relation to patient, donor, and operation related variables were assessed after multivariate analysis.
Actual 1-, 3-, and 5-year patient survivals were 86%, 79%, and 73%, respectively.
A high Child-Pugh (C-P) score or C-P class C, high donor age, high blood loss index, and re-transplantation were predictive factors that influenced patient survival.
A high blood loss index correlated with biliary atresia, low recipient age and weight, and with previous upper abdominal operations.
The donor's duration of stay at the intensive care unit was a predictive factor for retransplantation.
Dr Egbert Sieders concluded on behalf of the group that, "Children with diseases eligible for liver transplantation should be seen early in the course of their disease in a transplantation center.
"All possible measures should be taken during the transplantation procedure to keep the blood loss at a minimum. Children with biliary atresia deserve special attention in this respect. In addition, the choice of donor has implications for survival."