A 10-Year United Network for Organ Sharing Review of Mortality and Risk Factors in Young Children Awaiting Liver Transplantation

被引:42
作者
Leung, Daniel H. [1 ,2 ]
Narang, Amrita [1 ]
Minard, Charles G. [3 ]
Hiremath, Girish [1 ]
Goss, John A. [4 ]
Shepherd, Ross [1 ,2 ]
机构
[1] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[2] Texas Childrens Hosp, Div Pediat Gastroenterol Hepatol & Nutr, 6621 Fannin St,CCC 1010, Houston, TX 77030 USA
[3] Dan L Duncan Inst Clin & Translat Res, Houston, TX USA
[4] Texas Childrens Hosp, Baylor Coll Med, Div Abdominal Transplant Surg, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
BILIARY ATRESIA; ALAGILLE-SYNDROME; ALLOCATION; DISEASE; ANOMALIES; SYSTEM;
D O I
10.1002/lt.24605
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Young children < 2 years of age with chronic end-stage liver disease (YC2) are a uniquely vulnerable group listed for liver transplantation, characterized by a predominance of biliary atresia (BA). To investigate wait-list mortality, associated risk factors, and outcomes of YC2, we evaluated United Network for Organ Sharing registry data from April 2003 to March 2013 for YC2 listed for deceased donor transplant (BA = 994; other chronic liver disease [CLD] = 221). Overall, wait-list mortality among YC2 was 12.4% and posttransplant mortality was 8%, accounting for an overall postlisting mortality of 19.6%. YC2 demonstrated 12.2%, 18.7%, and 20.6% wait-list mortality by 90, 180, and 270 days, respectively. YC2 with CLD demonstrated significantly higher wait-list mortality compared with BA among YC2 (23.9% versus 9.8%; P < 0.05). Multivariate analyses revealed that listing Pediatric End-Stage Liver Disease [PELD] > 21 (hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.6-6.5), lack of exception (HR, 5.8; 95% CI, 2.8-11.8), listing height < 60.6 cm (HR, 2.1; 95% CI, 1.4-3.1), listing weight > 10 kg (HR, 3.8; 95% CI, 1.5-9.2), and initial creatinine > 0.5 (HR, 6.8; 95% CI, 3.4-13.5) were independent risk factors for YC2 wait-list mortality (P < 0.005 for all). Adjusting for all variables, the risk of death among CLD patients was 2 (95% CI, 1.3-3.1) times greater than patients with BA + surgery (presumed Kasai). Furthermore, the risk of death in BA surgery was 1.9 (95% CI, 1-3.4) times greater than BA with presumed Kasai. Our data highlight unacceptably high wait-list and early post-liver transplant mortality in YC2 not predicted by PELD and suggest key risk factors deserving of further study in this age group.
引用
收藏
页码:1584 / 1592
页数:9
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