Journal
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
Volume 74, Issue 6, Pages 750-756Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MPG.0000000000003448
Keywords
bilirubin; liver transplant; outcome; pediatric acute liver failure; scientific registry of transplant recipients; waitlist
Funding
- Washington University Institute of Clinical and Translational Sciences [UL1 TR000448]
- National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH)
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This study characterized recent outcomes in US pediatric acute liver failure (PALF) subjects listed for liver transplantation (LT) and found that PALF subjects had worse LT waitlist and post-LT outcomes compared to non-PALF subjects.
Background: We characterized recent outcomes in US pediatric acute liver failure (PALF) subjects listed for liver transplantation (LT) using the Scientific Registry of Transplant Recipients (SRTR) database. Methods: Pediatric subjects listed for LT from 2002 to 2015 were assigned to the PALF group based on status 1/1A listing, INR >2, no hepatic artery thrombosis, and no primary graft nonfunction (N = 397). Subjects were assigned to the non-PALF group if listed with any status other than 1/1A (N = 4509). Results: The PALF group had more infants <3 months of age and males at listing for LT compared to the non-PALF group. Two-thirds of PALF subjects had an indeterminate etiology. LT waitlist survival was significantly worse in the PALF group compared to the non-PALF group. Likelihood of removal from the LT waitlist for being too sick was higher, while that of removal for spontaneous recovery was lower in PALF subjects. Post-LT short-term (30 days) and long-term (60 months) outcomes were also significantly worse in PALF versus non-PALF subjects. PALF subjects who underwent living-donor-liver-transplant (LDLT) had similar LT waitlist times and post-LT survival compared to those undergoing deceased-donor-liver-transplant (DDLT). Over the study period, we observed a decreased number of liver transplants, and increase in LT waitlist- and short-term post-LT-survival in PALF subjects. Conclusion: LT waitlist and post-LT outcomes are worse in PALF subjects compared to non-PALF subjects. PALF subjects who undergo LDLT have similar waitlist times and post-LT outcomes compared to those undergoing DDLT.
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