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A Multivariate Analysis of Pre-, Peri-, and Post-Transplant Factors Affecting Outcome After Pediatric Liver Transplantation

McDiarmid, Sue V. MD; Anand, Ravinder PhD; Martz, Karen BS; Millis, Michael J. MD; Mazariegos, George MD

doi: 10.1097/SLA.0b013e31821ad86a
Original Articles
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Objective: The purpose of this study was to identify significant, independent factors that predicted 6 month patient and graft survival after pediatric liver transplantation.

Summary Background Data: The Studies of Pediatric Liver Transplantation (SPLIT) is a multicenter database established in 1995, of currently more than 4000 US and Canadian children undergoing liver transplantation. Previous published analyses from this data have examined specific factors influencing outcome. This study analyzes a comprehensive range of factors that may influence outcome from the time of listing through the peri- and postoperative period.

Methods: A total of 42 pre-, peri- and posttransplant variables evaluated in 2982 pediatric recipients of a first liver transplant registered in SPLIT significant at the univariate level were included in multivariate models.

Results: In the final model combining all baseline and posttransplant events, posttransplant complications had the highest relative risk of death or graft loss. Reoperation for any cause increased the risk for both patient and graft loss by 11 fold and reoperation exclusive of specific complications by 4 fold. Vascular thromboses, bowel perforation, septicemia, and retransplantation, each independently increased the risk of patient and graft loss by 3 to 4 fold. The only baseline factor with a similarly high relative risk for patient and graft loss was recipient in the intensive care unit (ICU) intubated at transplant. A significant center effect was also found but did not change the impact of the highly significant factors already identified.

Conclusions: We conclude that the most significant factors predicting patient and graft loss at 6 months in children listed for transplant are posttransplant surgical complications.

From the Department of Pediatrics and Surgery, University of California, Los Angeles (Dr McDiarmid); Biostatistics, The Emmes Corporation, Rockville, Maryland (Dr Anand and Ms Martz); Department of Surgery, University of Chicago, Chicago, Illinois (Dr Millis); and Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (Dr Mazariegos). The SPLIT Research Group.

Reprints: Sue V. McDiarmid, MD, UCLA Medical Center, Rm 12-383 MDCC, 10833 Le Conte Ave, Los Angeles, CA 90095. E-mail: smcdiarmid@mednet.ucla.edu.

Supported by a grant from the NIH (U01 DK061693-01A1. Additional support provided by Astellas Pharma US, Inc, and Roche Laboratories.

© 2011 Lippincott Williams & Wilkins, Inc.