Causes of late mortality in pediatric liver transplant recipients

Debra L. Sudan, Byers W. Shaw, Alan Norman Langnas

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Objective: This study was undertaken to review the incidence and causes of death in children who have survived long-term (more than 1 year) after liver transplantation (LT). Summary Background Data: No studies of the causes of late mortality in pediatric LT recipients are currently available in the literature. Methods: The study group consists of 212 pediatric patients who survived more than 1 year after LT. Twenty-three of these patients subsequently died (mean follow-up = 5.3 yr). Hospital records, office charts, and autopsy records were reviewed retrospectively to identify the causes of death. The patients who died were further evaluated by age, gender, length of survival, primary diagnosis, immunosuppression, and retransplantation. Results: The most common cause of death was graft failure, followed closely by infection. In patients dying from graft failure, eight of the nine patients underwent retransplantation and no child survived more then three liver transplants. Overwhelming infections occurred suddenly in eight children who had been previously healthy. Noncompliance was the third most common cause of death, primarily in older children. One child died from a posttransplant lymphoproliferative disorder (PTLD). Actuarial survival at 10 years is 83.7% (based on 100% survival at 1 year). There was no difference in survival based on primary disease. Retransplantation was far more prevalent in the nonsurvivors (47.8%) compared with survivors (13.7%) (p < 0.05). There were no significant differences in survival based on age, gender, or immunosuppression. Conclusions: Late mortality in children continues to be directly related to complications of LT and immunosuppression, even after the first year of transplantation. This is in contrast to adult liver transplant recipients, where approximately 50% of late deaths were related to LT and the remainder were because of unrelated illnesses.

Original languageEnglish (US)
Pages (from-to)289-295
Number of pages7
JournalAnnals of surgery
Volume227
Issue number2
DOIs
StatePublished - Feb 1 1998

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Liver Transplantation
Pediatrics
Cause of Death
Survival
Mortality
Liver
Immunosuppression
Transplants
Child Mortality
Lymphoproliferative Disorders
Hospital Records
Infection
Survivors
Autopsy
Transplantation
Transplant Recipients
Incidence

ASJC Scopus subject areas

  • Surgery

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Causes of late mortality in pediatric liver transplant recipients. / Sudan, Debra L.; Shaw, Byers W.; Langnas, Alan Norman.

In: Annals of surgery, Vol. 227, No. 2, 01.02.1998, p. 289-295.

Research output: Contribution to journalArticle

Sudan, Debra L. ; Shaw, Byers W. ; Langnas, Alan Norman. / Causes of late mortality in pediatric liver transplant recipients. In: Annals of surgery. 1998 ; Vol. 227, No. 2. pp. 289-295.
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abstract = "Objective: This study was undertaken to review the incidence and causes of death in children who have survived long-term (more than 1 year) after liver transplantation (LT). Summary Background Data: No studies of the causes of late mortality in pediatric LT recipients are currently available in the literature. Methods: The study group consists of 212 pediatric patients who survived more than 1 year after LT. Twenty-three of these patients subsequently died (mean follow-up = 5.3 yr). Hospital records, office charts, and autopsy records were reviewed retrospectively to identify the causes of death. The patients who died were further evaluated by age, gender, length of survival, primary diagnosis, immunosuppression, and retransplantation. Results: The most common cause of death was graft failure, followed closely by infection. In patients dying from graft failure, eight of the nine patients underwent retransplantation and no child survived more then three liver transplants. Overwhelming infections occurred suddenly in eight children who had been previously healthy. Noncompliance was the third most common cause of death, primarily in older children. One child died from a posttransplant lymphoproliferative disorder (PTLD). Actuarial survival at 10 years is 83.7{\%} (based on 100{\%} survival at 1 year). There was no difference in survival based on primary disease. Retransplantation was far more prevalent in the nonsurvivors (47.8{\%}) compared with survivors (13.7{\%}) (p < 0.05). There were no significant differences in survival based on age, gender, or immunosuppression. Conclusions: Late mortality in children continues to be directly related to complications of LT and immunosuppression, even after the first year of transplantation. This is in contrast to adult liver transplant recipients, where approximately 50{\%} of late deaths were related to LT and the remainder were because of unrelated illnesses.",
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