Outcome of Critically-Ill Children After Living-Donor Liver Transplant

Objectives: The outcome of children who had living-donor liver transplant was analyzed according to their status before transplant, and we analyzed the outcome of critically ill patients. Materials and Methods: This was a retrospective analysis of children who received primary living-donor liver transplant at Kyoto University Hospital. According to the criteria of the United Network for Organ Sharing, we divided patients into 3 groups: Group A patients had been admitted to the intensive care unit before living-donor liver transplant; Group B patients were hospitalized but did not require intensive care unit stay; and Group C patients were living at home and underwent elective transplant. Results: A total 685 patients met inclusion criteria. Children in Group A were younger than Group B and received liver grafts from younger donors than Group B and C. Group A patients had marked impairment in liver and renal function and coagulation profile and needed higher volumes of fresh frozen plasma transfusions. Group A patients had significantly worse outcomes and early patient death than the other group; Group A patient survival was 68.3%, 63.2%, 60.1%, and 56.1% at 1, 5, 10, and 15 years after living-donor liver transplant (P<.0001). Group A had worse graft survival than other groups (P<.0001), and Group A graft survival was 68.3%, 65.9%, 54.1%, and 49.9% at 1, 5, 10, and 15 years. Low gamma-glutamyl transpeptidase was an independent risk factor for patient death in Group A (hazard ratio, 1.004; 95% confidence interval, 1.0-1.007) (P<.05). Group A patients had a higher rate of multidrug-resistant hospital-acquired infections. Conclusions: Children who were admitted to the intensive care unit prior to living-donor liver transplant had marked impairment of pretransplant laboratory parameters and worse outcome than other groups.