Pediatric liver transplantation

A single center experience spanning 20 years

Ashokkumar Jain, George Mazariegos, Randeep Kashyap, Beverly Kosmach-Park, T. E. Starzl, John Fung, Jorge Reyes

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Background. Survival after liver transplantation has improved significantly over the last decade with pediatric recipients faring better than adults. The 20-year experience of pediatric liver transplantation at Children's Hospital of Pittsburgh is reported in terms of patient survival; graft survival in relation to age, gender, and immunosuppressive protocols; causes of death; and indications for retransplantation. Method. From March 1981 to April 1998, 808 children received liver transplants at Children's Hospital of Pittsburgh. All patients were followed until March 2001, with a mean follow-up of 12.2±3.9 years (median= 12.6; range=2.9-20). There were 405 female (50.2%) and 403 male (49.8%) pediatric recipients. Mean age at transplant was 5.3±4.9 years (mean=3.3; range 0.04-17.95), with 285 children (25.3%) being less than 2 years of age at transplant. Cyclosporine (CsA)-based immunosuppression was used before November 1989 in 482 children (50.7%), and the subsequent 326 recipients (40.3%) were treated with tacrolimus-based immunosuppression. Actuarial survival was calculated using the Kaplan-Meier statistical method. Differences in survival were calculated by log-rank analysis. Results. Overall patient survival at 1, 5, 10, 15 and 20 years was 77.1%, 72.6%, 69.4%, 65.8% and 64.4%, respectively. There was no difference in survival for male or female patients at any time point. At up to 10 years posttransplant, the survival for children greater than 2 years of age (79.5%, 75.7%, and 71.6% at 1, 5, and 10 years, respectively) was slightly higher than those at less than 2 years of age (72.6%, 66.9%, and 65.3% at 1, 5, and 10 years, respectively). However, at 15 and 20 years posttransplant, survival rates were similar (>2 years=67.3% and 65.8%; <2 years=64.1% and 64.1%). A significant difference in survival was seen in CsA-based immunosuppression (71.2%, 68.1%, 65.4%, and 61%) versus tacrolimus-based immunosuppression (85.8%, 84.7%, 83.3%, and 82.9%) at 1, 3, 5, and 10 years, respectively (P=0.0001). The maximum difference in survival was noted in the first 3 months between CsA and tacrolimus; thus, indicating there may have been other factors (nonimmunological factors) involved in terms of donor and recipient selection and technical issues. The mean annual death rate beyond 2 years posttransplant was 0.47%, with the mean annual death rate for patients who received tacrolimus-based immunosuppression being significantly lower than those who received CsA-based immunosuppression (0.14% vs. 0.8%; P=0.001). The most common etiologies of graft loss were hepatic artery thrombosis (33.4%), acute or chronic rejection (26.6%), and primary nonfunction (16.7%). Of note, retransplantation for graft loss because of acute or chronic rejection occurred only in those patients who received CsA-based immunosuppression. Conclusion. The overall 20-year actuarial survival for pediatric liver transplantation is 64%. Survival has increased by 20% in the last 12 years with tacrolimus-based immunosuppression. although this improvement may be the result of several factors, retransplantation as a result of acute or chronic rejection has been completely eliminated in patient treated with tacrolimus.

Original languageEnglish (US)
Pages (from-to)941-947
Number of pages7
JournalTransplantation
Volume73
Issue number6
DOIs
StatePublished - Mar 27 2002

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Liver Transplantation
Pediatrics
Immunosuppression
Survival
Tacrolimus
Transplants
sorbitan monolaurate
Donor Selection
Mortality
Hepatic Artery
Graft Survival
Immunosuppressive Agents
Cyclosporine
Cause of Death
Thrombosis
Survival Rate
Liver

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Jain, A., Mazariegos, G., Kashyap, R., Kosmach-Park, B., Starzl, T. E., Fung, J., & Reyes, J. (2002). Pediatric liver transplantation: A single center experience spanning 20 years. Transplantation, 73(6), 941-947. https://doi.org/10.1097/00007890-200203270-00020
Jain, Ashokkumar ; Mazariegos, George ; Kashyap, Randeep ; Kosmach-Park, Beverly ; Starzl, T. E. ; Fung, John ; Reyes, Jorge. / Pediatric liver transplantation : A single center experience spanning 20 years. In: Transplantation. 2002 ; Vol. 73, No. 6. pp. 941-947.
@article{216c22d95f384868b0d6afc6ddef4cb6,
title = "Pediatric liver transplantation: A single center experience spanning 20 years",
abstract = "Background. Survival after liver transplantation has improved significantly over the last decade with pediatric recipients faring better than adults. The 20-year experience of pediatric liver transplantation at Children's Hospital of Pittsburgh is reported in terms of patient survival; graft survival in relation to age, gender, and immunosuppressive protocols; causes of death; and indications for retransplantation. Method. From March 1981 to April 1998, 808 children received liver transplants at Children's Hospital of Pittsburgh. All patients were followed until March 2001, with a mean follow-up of 12.2±3.9 years (median= 12.6; range=2.9-20). There were 405 female (50.2{\%}) and 403 male (49.8{\%}) pediatric recipients. Mean age at transplant was 5.3±4.9 years (mean=3.3; range 0.04-17.95), with 285 children (25.3{\%}) being less than 2 years of age at transplant. Cyclosporine (CsA)-based immunosuppression was used before November 1989 in 482 children (50.7{\%}), and the subsequent 326 recipients (40.3{\%}) were treated with tacrolimus-based immunosuppression. Actuarial survival was calculated using the Kaplan-Meier statistical method. Differences in survival were calculated by log-rank analysis. Results. Overall patient survival at 1, 5, 10, 15 and 20 years was 77.1{\%}, 72.6{\%}, 69.4{\%}, 65.8{\%} and 64.4{\%}, respectively. There was no difference in survival for male or female patients at any time point. At up to 10 years posttransplant, the survival for children greater than 2 years of age (79.5{\%}, 75.7{\%}, and 71.6{\%} at 1, 5, and 10 years, respectively) was slightly higher than those at less than 2 years of age (72.6{\%}, 66.9{\%}, and 65.3{\%} at 1, 5, and 10 years, respectively). However, at 15 and 20 years posttransplant, survival rates were similar (>2 years=67.3{\%} and 65.8{\%}; <2 years=64.1{\%} and 64.1{\%}). A significant difference in survival was seen in CsA-based immunosuppression (71.2{\%}, 68.1{\%}, 65.4{\%}, and 61{\%}) versus tacrolimus-based immunosuppression (85.8{\%}, 84.7{\%}, 83.3{\%}, and 82.9{\%}) at 1, 3, 5, and 10 years, respectively (P=0.0001). The maximum difference in survival was noted in the first 3 months between CsA and tacrolimus; thus, indicating there may have been other factors (nonimmunological factors) involved in terms of donor and recipient selection and technical issues. The mean annual death rate beyond 2 years posttransplant was 0.47{\%}, with the mean annual death rate for patients who received tacrolimus-based immunosuppression being significantly lower than those who received CsA-based immunosuppression (0.14{\%} vs. 0.8{\%}; P=0.001). The most common etiologies of graft loss were hepatic artery thrombosis (33.4{\%}), acute or chronic rejection (26.6{\%}), and primary nonfunction (16.7{\%}). Of note, retransplantation for graft loss because of acute or chronic rejection occurred only in those patients who received CsA-based immunosuppression. Conclusion. The overall 20-year actuarial survival for pediatric liver transplantation is 64{\%}. Survival has increased by 20{\%} in the last 12 years with tacrolimus-based immunosuppression. although this improvement may be the result of several factors, retransplantation as a result of acute or chronic rejection has been completely eliminated in patient treated with tacrolimus.",
author = "Ashokkumar Jain and George Mazariegos and Randeep Kashyap and Beverly Kosmach-Park and Starzl, {T. E.} and John Fung and Jorge Reyes",
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language = "English (US)",
volume = "73",
pages = "941--947",
journal = "Transplantation",
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Jain, A, Mazariegos, G, Kashyap, R, Kosmach-Park, B, Starzl, TE, Fung, J & Reyes, J 2002, 'Pediatric liver transplantation: A single center experience spanning 20 years', Transplantation, vol. 73, no. 6, pp. 941-947. https://doi.org/10.1097/00007890-200203270-00020

Pediatric liver transplantation : A single center experience spanning 20 years. / Jain, Ashokkumar; Mazariegos, George; Kashyap, Randeep; Kosmach-Park, Beverly; Starzl, T. E.; Fung, John; Reyes, Jorge.

In: Transplantation, Vol. 73, No. 6, 27.03.2002, p. 941-947.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pediatric liver transplantation

T2 - A single center experience spanning 20 years

AU - Jain, Ashokkumar

AU - Mazariegos, George

AU - Kashyap, Randeep

AU - Kosmach-Park, Beverly

AU - Starzl, T. E.

AU - Fung, John

AU - Reyes, Jorge

PY - 2002/3/27

Y1 - 2002/3/27

N2 - Background. Survival after liver transplantation has improved significantly over the last decade with pediatric recipients faring better than adults. The 20-year experience of pediatric liver transplantation at Children's Hospital of Pittsburgh is reported in terms of patient survival; graft survival in relation to age, gender, and immunosuppressive protocols; causes of death; and indications for retransplantation. Method. From March 1981 to April 1998, 808 children received liver transplants at Children's Hospital of Pittsburgh. All patients were followed until March 2001, with a mean follow-up of 12.2±3.9 years (median= 12.6; range=2.9-20). There were 405 female (50.2%) and 403 male (49.8%) pediatric recipients. Mean age at transplant was 5.3±4.9 years (mean=3.3; range 0.04-17.95), with 285 children (25.3%) being less than 2 years of age at transplant. Cyclosporine (CsA)-based immunosuppression was used before November 1989 in 482 children (50.7%), and the subsequent 326 recipients (40.3%) were treated with tacrolimus-based immunosuppression. Actuarial survival was calculated using the Kaplan-Meier statistical method. Differences in survival were calculated by log-rank analysis. Results. Overall patient survival at 1, 5, 10, 15 and 20 years was 77.1%, 72.6%, 69.4%, 65.8% and 64.4%, respectively. There was no difference in survival for male or female patients at any time point. At up to 10 years posttransplant, the survival for children greater than 2 years of age (79.5%, 75.7%, and 71.6% at 1, 5, and 10 years, respectively) was slightly higher than those at less than 2 years of age (72.6%, 66.9%, and 65.3% at 1, 5, and 10 years, respectively). However, at 15 and 20 years posttransplant, survival rates were similar (>2 years=67.3% and 65.8%; <2 years=64.1% and 64.1%). A significant difference in survival was seen in CsA-based immunosuppression (71.2%, 68.1%, 65.4%, and 61%) versus tacrolimus-based immunosuppression (85.8%, 84.7%, 83.3%, and 82.9%) at 1, 3, 5, and 10 years, respectively (P=0.0001). The maximum difference in survival was noted in the first 3 months between CsA and tacrolimus; thus, indicating there may have been other factors (nonimmunological factors) involved in terms of donor and recipient selection and technical issues. The mean annual death rate beyond 2 years posttransplant was 0.47%, with the mean annual death rate for patients who received tacrolimus-based immunosuppression being significantly lower than those who received CsA-based immunosuppression (0.14% vs. 0.8%; P=0.001). The most common etiologies of graft loss were hepatic artery thrombosis (33.4%), acute or chronic rejection (26.6%), and primary nonfunction (16.7%). Of note, retransplantation for graft loss because of acute or chronic rejection occurred only in those patients who received CsA-based immunosuppression. Conclusion. The overall 20-year actuarial survival for pediatric liver transplantation is 64%. Survival has increased by 20% in the last 12 years with tacrolimus-based immunosuppression. although this improvement may be the result of several factors, retransplantation as a result of acute or chronic rejection has been completely eliminated in patient treated with tacrolimus.

AB - Background. Survival after liver transplantation has improved significantly over the last decade with pediatric recipients faring better than adults. The 20-year experience of pediatric liver transplantation at Children's Hospital of Pittsburgh is reported in terms of patient survival; graft survival in relation to age, gender, and immunosuppressive protocols; causes of death; and indications for retransplantation. Method. From March 1981 to April 1998, 808 children received liver transplants at Children's Hospital of Pittsburgh. All patients were followed until March 2001, with a mean follow-up of 12.2±3.9 years (median= 12.6; range=2.9-20). There were 405 female (50.2%) and 403 male (49.8%) pediatric recipients. Mean age at transplant was 5.3±4.9 years (mean=3.3; range 0.04-17.95), with 285 children (25.3%) being less than 2 years of age at transplant. Cyclosporine (CsA)-based immunosuppression was used before November 1989 in 482 children (50.7%), and the subsequent 326 recipients (40.3%) were treated with tacrolimus-based immunosuppression. Actuarial survival was calculated using the Kaplan-Meier statistical method. Differences in survival were calculated by log-rank analysis. Results. Overall patient survival at 1, 5, 10, 15 and 20 years was 77.1%, 72.6%, 69.4%, 65.8% and 64.4%, respectively. There was no difference in survival for male or female patients at any time point. At up to 10 years posttransplant, the survival for children greater than 2 years of age (79.5%, 75.7%, and 71.6% at 1, 5, and 10 years, respectively) was slightly higher than those at less than 2 years of age (72.6%, 66.9%, and 65.3% at 1, 5, and 10 years, respectively). However, at 15 and 20 years posttransplant, survival rates were similar (>2 years=67.3% and 65.8%; <2 years=64.1% and 64.1%). A significant difference in survival was seen in CsA-based immunosuppression (71.2%, 68.1%, 65.4%, and 61%) versus tacrolimus-based immunosuppression (85.8%, 84.7%, 83.3%, and 82.9%) at 1, 3, 5, and 10 years, respectively (P=0.0001). The maximum difference in survival was noted in the first 3 months between CsA and tacrolimus; thus, indicating there may have been other factors (nonimmunological factors) involved in terms of donor and recipient selection and technical issues. The mean annual death rate beyond 2 years posttransplant was 0.47%, with the mean annual death rate for patients who received tacrolimus-based immunosuppression being significantly lower than those who received CsA-based immunosuppression (0.14% vs. 0.8%; P=0.001). The most common etiologies of graft loss were hepatic artery thrombosis (33.4%), acute or chronic rejection (26.6%), and primary nonfunction (16.7%). Of note, retransplantation for graft loss because of acute or chronic rejection occurred only in those patients who received CsA-based immunosuppression. Conclusion. The overall 20-year actuarial survival for pediatric liver transplantation is 64%. Survival has increased by 20% in the last 12 years with tacrolimus-based immunosuppression. although this improvement may be the result of several factors, retransplantation as a result of acute or chronic rejection has been completely eliminated in patient treated with tacrolimus.

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Jain A, Mazariegos G, Kashyap R, Kosmach-Park B, Starzl TE, Fung J et al. Pediatric liver transplantation: A single center experience spanning 20 years. Transplantation. 2002 Mar 27;73(6):941-947. https://doi.org/10.1097/00007890-200203270-00020