About 9% to 29% of pediatric liver transplant recipients require retransplantation.
No previous pediatric study has proposed a prognostic scoring system.
Dr Adam Davis and colleagues from California, USA used the United Network for Organ Sharing transplantation database to conduct a retrospective cohort study of 1130 patients who were less than 18 years of age when they received their retransplant.
The team used a random two-thirds of the subjects to develop a prognostic scoring system by performing a multivariate Cox analysis with non-laboratory clinical characteristics.
The scoring system was verified in the remaining one-third of the subjects.
|Protective factors in the scoring system included older age at the time of transplant|
|Liver Transplantation |
The researchers found that stratifying the verification group into risk groups by prognostic score demonstrated its predictive value.
Those in the low-risk category had survival similar to that of primary liver transplant recipients.
Those in the high-risk category had just over 2 times the risk of death or retransplantation as those in the low-risk category.
Risk factors in the scoring system included being on life support at the time of retransplant, receiving a split liver graft, and having an original diagnosis of neonatal cholestasis, familial cholestasis, paucity of bile ducts, or congenital abnormalities.
The team noted that protective factors in the scoring system included older age at the time of transplantation and having acute rejection contribute to graft failure.
Dr Davis’ team concluded, “With simple clinical characteristics, this scoring tool can modestly discriminate between those children at high risk and those children at low risk of poor outcome after liver retransplantation.”