Early Living Donor Liver Transplant Is Associated With Improved Graft‐ and Patient‐Survival Outcomes in Children With Biliary Atresia
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
ABSTRACT Introduction Biliary atresia () is the most common indication for pediatric liver transplantation. Pediatric end‐stage liver disease () scores primarily determine deceased donor liver transplant () waitlist priority. Due to persistent donor supply–demand mismatch, children typically have advanced disease and highscores at the time of. Proactive living donor liver transplant () may facilitate transplantation before critical illness. We hypothesized that early, low,is associated with improved graft and patient survival in children with petr70367-sec-0001 Methods We retrospectively reviewed children undergoing liver transplantation forin thedatabase, comparingto, stratified by. Early transplant was defined as transplant with a≤ 12. Four groups were analyzed: low, low, high, and high. Kaplan–Meier and Cox‐proportional hazards analyses evaluated patient‐ and graft‐survival. petr70367-sec-0002 Results 4733 children meeting inclusion criteria were included (= 249 Low PELD LDLT,= 1152 Low PELD DDLT,= 708 High PELD LDLT,= 2624 High PELD DDLT). Prior to transplant, Low PELD LDLT recipients had lower INR and bilirubin levels, and required less life support (< 0.01). Kaplan–Meier analyses showed the highest 5‐year graft and patient survival in the Low PELD LDLT (< 0.01). Cox modeling revealed an independent association between low PELD LDLT and decreased graft loss (adjusted HR 0.45,< 0.01) and mortality (adjusted HR 0.43,= 0.03). petr70367-sec-0003 Conclusions A proactive appro
Abstract
ABSTRACT Introduction Biliary atresia () is the most common indication for pediatric liver transplantation. Pediatric end‐stage liver disease () scores primarily determine deceased donor liver transplant () waitlist priority. Due to persistent donor supply–demand mismatch, children typically have advanced disease and highscores at the time of. Proactive living donor liver transplant () may facilitate transplantation before critical illness. We hypothesized that early, low,is associated with improved graft and patient survival in children with petr70367-sec-0001 Methods We retrospectively reviewed children undergoing liver transplantation forin thedatabase, comparingto, stratified by. Early transplant was defined as transplant with a≤ 12. Four groups were analyzed: low, low, high, and high. Kaplan–Meier and Cox‐proportional hazards analyses evaluated patient‐ and graft‐survival. petr70367-sec-0002 Results 4733 children meeting inclusion criteria were included (= 249 Low PELD LDLT,= 1152 Low PELD DDLT,= 708 High PELD LDLT,= 2624 High PELD DDLT). Prior to transplant, Low PELD LDLT recipients had lower INR and bilirubin levels, and required less life support (< 0.01). Kaplan–Meier analyses showed the highest 5‐year graft and patient survival in the Low PELD LDLT (< 0.01). Cox modeling revealed an independent association between low PELD LDLT and decreased graft loss (adjusted HR 0.45,< 0.01) and mortality (adjusted HR 0.43,= 0.03). petr70367-sec-0003 Conclusions A proactive approach toin children withis associated with improved long‐term graft and patient survival. Lowshould be considered to increase early transplant access for children with. petr70367-sec-0004 A proactive approach to living donor liver transplant in children with biliary atresia is associated with improved long‐term graft and patient survival. Low PELD living donor transplant should be considered to increase early transplant access for children with biliary atresia. graphical