Transplantation 1999 Sep 15;68(5):650-5

An analysis of pretransplantation variables associated with long-term allograft outcome in pediatric liver transplant recipients receiving primary tacrolimus (FK506) therapy

Cacciarelli TV, Dvorchik I, Mazariegos GV, Gerber D, Jain AB, Fung JJ, Reyes J
Department of Transplant Surgery, Thomas E. Starzl Transplantation Institute,
University of Pittsburgh School of Medicine and Children's Hospital of
Pittsburgh, Pennsylvania 15213, USA

Abstract
BACKGROUND: The present study analyzes pretransplantation variables associated
with long-term liver allograft survival in 278 children who underwent
transplantation under primary tacrolimus (FK506) therapy at a single center
between October 1989 and October 1996. METHODS: The influence of 17
pretransplantation variables on long-term liver allograft outcome was analyzed.
Donor variables included age, weight, gender, and cold ischemia time. Recipient
variables included age, weight, gender, original liver disease,
pretransplantation waiting time, previous abdominal surgery, United Network of
Organ Sharing (UNOS) status, ABO blood group, bilirubin level, prothrombin time,
ammonia level, creatinine level, and reduced-size/split liver grafts. RESULTS:
Overall actuarial graft survival was 79.9% at 1 year, 79.1% at 2 years, and
78.3% at 3, 4, and 5 years. Retransplantation rate was 10.8%. Pretransplantation
variables with a significant adverse effect on graft survival by univariate
analysis were donor age < or = 1 year (P<0.004), donor weight < or = 10 kg
(P<0.003), UNOS status I and II (P<0.007), ABO type O, B, and AB (P<0.03), and
reduced-size/split liver grafts (P<0.02). Pretransplantation variables
significant by multivariate analysis and therefore independent predictors of
inferior graft outcome were donor weight '10 kg (relative risk [RR] 2.91,
confidence interval [CI] 1.53-5.51); reduced-size/split liver grafts (RR 2.53,
CI 1.30-5.64); and UNOS status I (RR 2.22, CI 1.11-4.43). CONCLUSIONS: Pediatric
liver transplant recipients receiving primary tacrolimus therapy have long-term
graft survival rates approaching 80%. UNOS status, donor weight, and the use of
reduced-size/split liver grafts are the most important factors affecting
survival