Reuters Health Information: Pediatric liver transplant patients have good long-term survival
Pediatric liver transplant patients have good long-term survival
Last Updated: 2016-04-22
By Megan Brooks
NEW YORK (Reuters Health) - Twenty-year survival after
pediatric liver transplantation (LT) can be expected to be close
to 80%, according to a new study.
"Until now there has been no good answer as to how long
children could be expected to live after liver transplantation,"
lead author Dr. Josefina Martinelli said in a news release from
the International Liver Congress 2016 in Barcelona, Spain,
sponsored by the European Association for the Study of the Liver
(EASL), where the results were presented April 14.
"While each child receiving a transplant is unique and
every procedure is different, this study provides robust
evidence on the average expected survival rates, an important
consideration for the parents of children who undergo this
complicated procedure," added Dr. Martinelli, from the Pediatric
Liver Unit, APHP-Bicetre Hospital, Paris, France.
The investigators took a look back at the medical records
of 128 consecutive children who underwent cadaveric LT (47 whole
liver, 77 partial liver and four split liver) at their center
from 1988 to 1993. The children had a median age of 2.5 years at
LT and were followed for an average of up 22 years.
Patient survival rates at five, 10, 15, and 20 years
post-LT were 84%, 82%, 80%, and 79%, respectively, and graft
survival rates were 73%, 72%, 67%, and 65%.
The most common complication was infection (59%), which
isn't surprising, Dr. Martinelli told Reuters Health.
"Infections, bacterial in particular, are among the most
frequent early complications. Poor nutritional status prior to
transplantation, surgical opening of the gut, catheters,
surgical drains, biliary complications, and tracheal tubes all
favor bacterial infection."
"In addition, viral primoinfections are frequent in these
very young patients who are seronegative for most viruses. Both
bacterial and viral infections are particularly severe in this
context because during the early posttransplant period the
immunosuppression is very strong to prevent early rejection of
the liver graft," Dr. Martinelli explained in email.
The second most common complications were acute (44%) and
chronic (37%) rejection. "Chronic kidney disease is a common
complication being close to 35% in long-term survivors. Liver
tests are normal in 60% of long-term survivors and final height
is acceptable for the majority despite steroids use in this
cohort," Dr. Martinelli 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," Professor Laurent Castera,
EASL secretary general, said in the release.
"We believe," Dr. Martinelli told Reuters Health, "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."
SOURCE: http://bit.ly/1ro5xCL
International Liver Congress 2016.
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