European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children.
Adolescent
Age Factors
Child
Europe
/ epidemiology
Female
Graft Rejection
/ epidemiology
Graft Survival
/ physiology
Humans
Infant
Liver Transplantation
/ adverse effects
Living Donors
/ statistics & numerical data
Male
Registries
/ statistics & numerical data
Time
Tissue and Organ Procurement
/ organization & administration
Transplantation Immunology
/ physiology
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
12
09
2021
received:
26
01
2021
accepted:
16
10
2021
pubmed:
2
11
2021
medline:
4
3
2022
entrez:
1
11
2021
Statut:
ppublish
Résumé
The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
Sections du résumé
BACKGROUND AND AIMS
The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968.
APPROACH AND RESULTS
Over a 50-year period (1968-2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000-2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found.
CONCLUSIONS
Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
634-645Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021 American Association for the Study of Liver Diseases.
Références
Starzl TE, Groth CG, Brettschneider L, Penn I, Fulginiti VA, Moon JB, et al. Orthotopic homotransplantation of the human liver. Ann Surg. 1968;168:392-415.
Angelico R, Nardi A, Adam R, Nadalin S, Polak WG, Karam V, et al. Outcomes of left split graft transplantation in Europe: report from the European Liver Transplant Registry. Transpl Int. 2018;31:739-50.
Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, et al. Society of Pediatric Liver Transplantation: Current registry status 2011-2018. Pediatr Transplant. 2020; 24:e13605.
Bezinover D, Deacutis MF, Dalal PG, Moore RP, Stine JG, Wang M, et al. Perioperative thrombotic complications associated with pediatric liver transplantation: a UNOS database evaluation. HPB (Oxford). 2019;21:370-8.
Kasahara M, Umeshita K, Sakamoto S, Fukuda A, Furukawa H, Sakisaka S, et al. Living donor liver transplantation for biliary atresia: an analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society. Am J Transplant. 2018;18:659-68.
US Department of Health and Human Services. Scientific Registry of Transplant Recipients. Published 2018. https://SRTR.transplant.hrsa.gov/annual_reports/2018/Liver.aspx#LI_127_tx_ped_GF_DD_5yr_age_1_b64
Bowring MG, Massie AB, Chu NM, Bae S, Schwarz KB, Cameron AM, et al. Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States. J Pediatr Gastroenterol Nutr. 2020;70:356-63.
Dharnidharka VR, Lamb KE, Zheng J, Schechtman KB, Meier-Kriesche HU. Across all solid organs, adolescent age recipients have worse transplant organ survival than younger age children: a US national registry analysis. Pediatr Transplant. 2015;19:471-6.
Ekong UD, Gupta NA, Urban R, Andrews WS. 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. Pediatr Transplant. 2019;23:e13523.
Adam R, Karam V, Cailliez V, O’Grady JG, Mirza D, Cherqui D, et al. 2018 Annual report of the European Liver Transplant Registry (ELTR)-50-year evolution of liver transplantation. Transpl Int. 2018;31:1293-317.
Jean-St-Michel E, Kaufman M, Dipchand AI. Suboptimal survival for adolescent solid organ transplant recipients: a call to action? Pediatr Transplant. 2015;19:439-40.
Sagar N, Leithead JA, Lloyd C, Smith M, Gunson BK, Adams DH, et al. Pediatric liver transplant recipients who undergo transfer to the adult healthcare service have good long-term outcomes. Am J Transplant. 2015;15:1864-73.
McDiarmid SV, Davies DB, Edwards EB. Improved graft survival of pediatric liver recipients transplanted with pediatric-aged liver donors. Transplantation. 2000;70:1283-91.
Loirat C, Chalem Y, Golmard JL. Organ allocation in pediatric transplantation in France. Pediatr Nephrol. 2001;16:964-70.
Angelico R, Trapani S, Spada M, Colledan M, Ville de Goyet J, Salizzoni M, et al. A national mandatory-split liver policy: a report from the Italian experience. Am J Transplant. 2019 Jul;19:2029-43.
Valentino PL, Emre S, Geliang G, Li L, Deng Y, Mulligan D, et al. Frequency of whole-organ in lieu of split-liver transplantation over the last decade: children experienced increased wait time and death. Am J Transplant. 2019;19:3114-23.
Perito ER, Roll G, Dodge JL, Rhee S, Roberts JP. Split liver transplantation and pediatric waitlist mortality in the United States: potential for improvement. Transplantation. 2019;103:552-7.
McDiarmid SV, Anand R, Martz K, Millis MJ, Mazariegos G. A multivariate analysis of pre-, peri-, and post-transplant factors affecting outcome after pediatric liver transplantation. Ann Surg. 2011;254:145-54.
Englesbe MJ, Kelly B, Goss J, Fecteau A, Mitchell J, Andrews W, et al. Reducing pediatric liver transplant complications: a potential roadmap for transplant quality improvement initiatives within North America. Am J Transplant. 2012;12:2301-6.
Emond J. Reducing complications in pediatric liver transplantation: do we have the answer? Am J Transplant. 2012;12:2267-68.
Grimaldi C, di Francesco F, Chiusolo F, Angelico R, Monti L, Muiesan P, et al. Aggressive prevention and preemptive management of vascular complications after pediatric liver transplantation: a major impact on graft survival and long-term outcome. Pediatr Transplant. 2018;22:e13288.
Neto JS, Fonseca EA, Vincenzi R, Pugliese R, Benavides MR, Roda K, et al. Technical choices in pediatric living donor liver transplantation: the path to reduce vascular complications and improve survival. Liver Transpl. 2020;2:1644-51.