G. Wortham2, M. Crawford2, J. Miggins2, A. Rana1, J.A. Goss1, N. Galván1 1Baylor College Of Medicine, Abdominal Surgery, Houston, TX, USA 2Baylor College Of Medicine, Houston, TX, USA
Introduction:
The purpose of this study is to assess what the diagnosis of cholestatic liver disease, including biliary atresia, has on 25-year survival rates and the factors associated with 25-year survival and morbidity after pediatric liver transplant.
Methods:
We conducted a retrospective analysis of pediatric liver transplant recipients from 1987 to 1998 using de-identified data from the OPTN 2023 Liver Database. 5,433 patients were included in the cohort prior to exclusions. Exclusions for multi-organ transplants (n=222), prior transplants and re-transplants (n=2,256), and deaths within one year (n=526) narrowed the cohort to 2,429 patients, of which 645 had a primary diagnosis of cholestatic disease. Univariate and multivariate analyses were performed to identify factors influencing 25-year survival.
Results:
Factors associated with increased likelihood of 25-year survival included a primary diagnosis of cholestatic disease (Odds Ratio: 0.67, Confidence Interval: 0.47 – 0.95), UNOS region 2 (Odds Ratio: 0.65, Confidence Interval: 0.48 – 0.90), and UNOS region 5 (Odds Ratio: 0.72, Confidence Interval: 0.53 – 0.99). Factors associated with decreased survival included recipient ages between 8-12 (Odds Ratio: 1.84, Confidence Interval: 1.16 – 2.91) and 12-18 (Odds Ratio: 2.90, Confidence Interval: 1.44 – 5.84), donor age over 19 (Odds Ratio: 1.42, Confidence Interval: 1.05 – 1.91), African-American recipient ethnicity (Odds Ratio: 1.94, Confidence Interval: 1.36 – 2.77), “other” recipient ethnicity (Odds Ratio: 2.49, Confidence Interval: 1.17 – 5.31), donor bilirubin levels above 2 mg/dL (Odds Ratio: 1.85, Confidence Interval: 1.10 – 3.15), and UNOS region 10 (Odds Ratio: 1.62, Confidence Interval: 1.13 – 2.32).
Conclusion:
This is the first study to examine factors influencing 25-year survival in pediatric liver transplant recipients, while accounting for a diagnosis of cholestatic disease. A diagnosis of cholestatic disease is associated with improved 25-year survival post-transplantation. Older recipient and donor ages, African-American and other minority recipient ethnicities, as well as elevated donor bilirubin, negatively impact long-term survival. Further research is warranted to determine rationale for outcome disparities that exist between UNOS regions.