Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 16;11(24):7480.
doi: 10.3390/jcm11247480.

Long-Term Survival Outcomes beyond the First Year after Liver Transplantation in Pediatric Acute Liver Failure Compared with Biliary Atresia: A Large-Volume Living Donor Liver Transplantation Single-Center Study

Sola Lee  1 , Nam-Joon Yi  1 , Eui Soo Han  1 , Su Young Hong  1 , Jeong-Moo Lee  1 , Suk Kyun Hong  1 , YoungRok Choi  1 , Hyun-Young Kim  1 , Joong Kee Youn  1 , Dayoung Ko  1 , Jae Sung Ko  2 , Jin Soo Moon  2 , Seong Mi Yang  3 , Kwang-Woong Lee  1 , Kyung-Suk Suh  1
Affiliations

Long-Term Survival Outcomes beyond the First Year after Liver Transplantation in Pediatric Acute Liver Failure Compared with Biliary Atresia: A Large-Volume Living Donor Liver Transplantation Single-Center Study

Sola Lee et al. J Clin Med. .

Abstract

Pediatric acute liver failure (PALF) is a common cause of liver transplantation (LT) but showed poor post-LT outcomes. We reviewed 36 PALF patients and 120 BA patients who underwent LT in our institution. The cause of PALF was unknown in 66.7%. PALF patients were older (6.2 vs. 2.9 years) with higher PELD scores (31.5 vs. 24.4) and shorter waitlist time (15.7 vs. 256.1 days) (p < 0.01). PALF patients showed higher rates of post-transplant renal replacement therapy (RRT) (13.9% vs. 4.2%) and hepatic artery complications (13.9% vs. 0.8%), while portal vein complications rates were lower (0% vs. 10.8%), (p < 0.05). Although PALF patients showed lower 5-year survival rates (77.8% vs. 95.0 %, p < 0.01), the 5-year survival rates of patients who lived beyond the first year were comparable (96.6% vs. 98.3%, p = 0.516). The most common cause of deaths within one year was graft failure (75.0%) in PALF patients, but infection (67.7%) in BA patients. In multivariate analysis, lower body weight, hepatic artery complications and post-transplant RRT were associated with worse survival outcomes (p < 0.05). In conclusion, physicians should be alert to monitor the immediate postoperative graft dysfunction and hepatic artery complications and patients on post-transplant RRT in order to improve survival outcomes in PALF patients.

Keywords: acute liver failure; hepatic artery; pediatric liver transplantation; rejection; renal replacement therapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection. Abbreviations: BA, biliary atresia; LT, liver transplantation; PALF, pediatric acute liver failure.
Figure 2
Figure 2
Survival graphs comparing biliary atresia and pediatric acute liver failure groups. (A) Patient survival rates. (B) Graft survival rates. Abbreviations: BA, biliary atresia; PALF, pediatric acute liver failure.
Figure 3
Figure 3
Survival rates in patients living beyond the first post-transplant year, comparing biliary atresia and pediatric acute liver failure groups. (A) Patient survival rates. (B) Graft survival rates. Abbreviations: BA, biliary atresia; PALF, pediatric acute liver failure.
Figure 4
Figure 4
Comparison of patient survival outcomes (biliary atresia vs. cryptogenic pediatric acute liver failure vs. other causes of pediatric acute liver failure). Abbreviations: BA, biliary atresia; PALF, pediatric acute liver failure.
See this image and copyright information in PMC

References

    1. Squires R.H., Jr., Shneider B.L., Bucuvalas J., Alonso E., Sokol R.J., Narkewicz M.R., Dhawan A., Rosenthal P., Rodriguez-Baez N., Murray K.F., et al. Acute liver failure in children: The first 348 patients in the pediatric acute liver failure study group. J. Pediatr. 2006;148:652–658. doi: 10.1016/j.jpeds.2005.12.051. - DOI - PMC - PubMed
    1. Burdelski M., Nolkemper D., Ganschow R., Sturm E., Malago M., Rogiers X., Brölsch C.E. Liver transplantation in children: Long-term outcome and quality of life. Eur. J. Pediatr. 1999;158((Suppl. 2)):S034–S042. doi: 10.1007/PL00014322. - DOI - PubMed
    1. Baliga P., Alvarez S., Lindblad A., Zeng L., The Studies of Pediatric Liver Transplantation (SPLIT) Research Group Posttransplant survival in pediatric fulminant hepatic failure: The SPLIT experience. Liver Transplant. 2004;10:1364–1371. doi: 10.1002/lt.20252. - DOI - PubMed
    1. Oh S.H., Kim K.M., Kim D.Y., Lee Y.J., Rhee K.W., Jang J.Y., Chang S.H., Lee S.Y., Kim J.-S., Choi B.H., et al. Long-term outcomes of pediatric living donor liver transplantation at a single institution. Pediatr. Transplant. 2010;14:870–878. doi: 10.1111/j.1399-3046.2010.01357.x. - DOI - PubMed
    1. Hong S.K., Yi N.-J., Yoon K.C., Kim M.S., Lee J.G., Lee S., Kang K.J., Hwang S., Ryu J.H., Hong K., et al. Outcomes of Pediatric Liver Transplantation in Korea Using Two National Registries. J. Clin. Med. 2020;9:3435. doi: 10.3390/jcm9113435. - DOI - PMC - PubMed

LinkOut - more resources