20‐ to 25‐year patient and graft survival following a single pediatric liver transplant—Analysis of the United Network of Organ Sharing database: Where to go from here

摘要

Abstract To understand factors contributing to liver graft loss and patient death, we queried a national database designed to follow pediatric patients transplanted between 1987 and 1995 till adulthood. A comparison was made to a cohort transplanted between 2000 and 2014. The 5‐, 10‐, 15‐, 20‐, and 25‐year patient survival and graft survival were 95.5%, 93.7%, 89.1%, 80.8%, and 73.1%, and 92.5%, 86.7%, 77.6%, 68.7%, and 62.2%, respectively. The twenty‐year patient/graft survival was significantly worse in those transplanted between 5 and 17?years of age compared to those transplanted at 5?years of age ( P ??0.001). For the modern era cohort, the 3‐year patient survival was significantly lower in children transplanted at 16‐17?years of age compared to those transplanted at 5 and 11‐15?years of age ( P ?≤?0.02). The 3‐year graft survival was similarly lower in children transplanted at 16‐17?years of age compared to those transplanted at 5, 5‐10, and 11‐15?years of age ( P ?≤?0.001). Infection as a cause of death occurred either early or 15?years post‐transplant. Chronic rejection remained the leading cause of graft loss in both cohorts and the commonest indication for retransplantation 20‐25?years following primary transplant. Further research is required to identify modifiable factors contributing to development of chronic rejection.