M. Crawford1, G. Wortham1, J. Miggins1, A. Rana1,2, J.A. Goss1,2, N. Galván1,2 1Baylor College Of Medicine, Houston, TX, USA 2Baylor College Of Medicine, Abdominal Surgery, Houston, TX, USA
Introduction:
As metabolic etiologies are the second most prevalent cause for pediatric liver transplantation, this study analyzes the long-term survival of these patients. As the UNOS database only accounts for transplants as far back as 1987, there has not been a sufficient population to evaluate 25-year outcomes of metabolic liver transplants until recently. Therefore, this study analyzes the factors that contribute to long term survival of metabolic patients beyond 25 years, given a 1-year survival post-transplant.
Methods:
2,429 pediatric liver transplant recipients prior to July 1998 who survived beyond 1 year post-transplant were retrospectively analyzed using de-identified data from the UNOS database. Patients were placed into either metabolic cohort (152 patients) or non-metabolic cohort (2,277 patients) based on their diagnosis at the time they were placed on the transplant list. Univariate and multivariate linear regression analysis controlling for 30 donor, recipient, and center-level risk factors were used to analyze factors contributing to likelihood of 25 year survival after transplantation.
Results:
Patients receiving liver transplantation to treat metabolic etiologies have significantly increased likelihood of 25 year survival (Odds Ratio [OR]: 0.42, Confidence Interval [CI]: 0.23-.76) than all other etiologies in congregate. When accounting for diagnosis of metabolic conditions, transplantation occurring in UNOS regions 2 (OR: .65, CI: 0.47-0.90) or 5 (OR: 0.71, CI: 0.52-0.98), and history of prior abdominal surgery (OR: 0.71, CI: 0.53-0.96) were found to significantly increase likelihood of 25 year survival. Recipient age ranges 8-12 years (OR: 1.86, CI: 1.18-2.95), 12-18 years (OR: 2.92, CI: 1.45-5.90), elevated donor bilirubin (OR:1.79, CI: 1.05-3.04) donor aged 19 or older (OR: 1.28, CI: 0.96-1.70), African American (OR: 1.94, CI: 1.36-2.78) or ‘Other’ ethnicity (OR: 2.63, CI: 1.24-5.56), and transplantation in UNOS region 10 (OR: 1.64, CI: 1.14-2.36) were found to significantly decrease likelihood of 25 year survival.
Conclusion:
This is the first study to retroactively characterize factors contributing to 25-year survival of pediatric liver transplant patients with metabolic disease. Although metabolic conditions have a high rate of long term survival, mortality can be further decreased by heightening caution in cases where recipients are older than 8 years old, donor bilirubin is elevated beyond 2 mg/dL, or the graft originates from a donor over 18 years of age.