Predicting early outcomes of liver transplantation in young children: The EARLY study

Rashid Alobaidi; Natalie Anton; Dominic Cave; Elham Khodayari Moez; Ari R Joffe

摘要

AIM To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years.METHODS This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015.Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form. Associations between potential predictor variables and outcomes were determined using univariate and multiple logistic [odds ratio(OR); 95%CI] or linear(effect size, ES; 95%CI) regressions. RESULTS There were 65 children, of mean age 11.9(SD 7.1) mo and weight 8.5(2.1) kg, with biliary-atresia in 40(62%), who had a living related donor [LRD; 29(45%)], split/reduced [21(32%)] or whole liver graft [15(23%)]. Outcomes after liver transplant included: ventilator-days of 12.5(14.1); pediatric intensive care unit mortality of 5(8%); re-operation in 33(51%), hepatic artery thrombosis(HAT) in 12(19%), portal vein thrombosis(PVT) in 11(17%), and any severe complication(HAT, PVT, bile leak, bowel perforation, intraabdominal infection, retransplant, or death) in 32(49%) patients. Predictors of the prespecified primary outcomes on multiple regression were:(1) HAT: split/reduced(OR 0.06; 0.01, 0.76; P = 0.030) or LRD(OR 0.16; 0.03, 0.95; P = 0.044) vs whole liver graft; and(2) ventilator-days: surgeon(P < 0.05), lowest antithrombin(AT) postoperative day 2-5(ES-0.24;-0.47,-0.02; P = 0.034), and split/reduced(ES-12.5;-21.8,-3.2; P = 0.009) vs whole-liver graft. Predictors of the pre-specified secondary outcomes on multiple regression were:(1) any thrombosis: LRD(OR 0.10; 0.01, 0.71; P = 0.021) or split/reduced(OR 0.10; 0.01, 0.85; P = 0.034) vs whole liver graft, and lowest AT postoperative day 2-5(OR 0.93; 0.87, 0.99; P = 0.038); and(2) any severe complication: surgeon(P < 0.05), lowest AT postoperative day 2-5(OR 0.92; 0.86-0.98; P = 0.016), and split/reduced(OR 0.06; 0.01, 0.78; P = 0.032) vs whole-liver graft. CONCLUSION In young children, whole liver graft and surgeon was associated with more complications, and higher AT postoperative day 2-5 was associated with fewer complications early after liver transplantation.

Predicting early outcomes of liver transplantation in young children: The EARLY study

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