Choosing a pediatric recipient for orthotopic liver transplantation

Abstract

Between March 3, 1981, and June 1, 1984, 216 children were evaluated for orthotopic liver transplantation. Of the 216 patients, 117 (55%) had received at least one liver transplant by June 1, 1985. Fifty-five (25%) died before transplantation. The 117 patients who received transplants were grouped according to severity of disease and degree of general decompensation at the time of transplantation. The severity of a patient's medical condition with the possible exception of deep hepatic coma, did not predict outcome following orthotopic liver transplantation. Seventy variables were assessed at the time of the evaluation. Twenty-three of the 70 variables were found to have prognostic significance with regard to death from progressive liver disease before transplantation. These 23 variables were incorporated into a multivariate model to provide a means of determining the relative risk of death among pediatric patients with end-stage liver disease. This information may allow more informed selection of candidates awaiting liver transplantation.

Fig 1

Actuarial survival curves in cyclosporine era of various clinical status groups over 4-year follow-up.

Fig 2

Comparison of survival curves for patients with positive and negative histories of ascites. N, number of patients at risk.

Fig. 3

Actuarial and multivariate model curves for patients at high, moderate, and low risk of death from progressive liver disease. Closeness of observed to multivariate model confirms adequacy of model for data. N, number of patients at risk.