Survival and Results

The 1999 Annual Report of the U.S. Scientific Registry of Transplant Recipients  and the Organ Procurement and Transplantation Network-Transplant Data: 1989-1998, reported for pediatric patient liver transplantation survival rates ranging from 78% to 90% at 3 years and 76% to 82% at 5 years, and graft survival rates ranging from 60% to 74% at 3 years and from 58% to 72% at 5 years.
These results are significantly improved in respect to the survival report from the ‘80s. Several parameters have been identified as predictors of graft and patient survival in pediatric patients.
In our series of 97 liver recipients, patient median time on the waiting list $ was 21 days, with a significant decrease from 60 days (October – December 1997) to 7 days (August – October 1999). No patient died on the waiting list.
Of the 97 transplanted patients $, 66 (68%) received a split liver, in 60 cases a left lateral segment, in 4 cases a left lobe and in 2 cases a right graft (segments I and IV to VIII). Six children (6%) received a reduced-size liver and the remaining 25 patients (26%) were transplanted with a whole organ.
At a median follow-up of 16 months (range 1-37), 81 patients (84%) are currently alive. Overall 6-month and 1-year actuarial patient survival rates $ are 87% and 84%, respectively. The 6-month and 1-year actuarial graft survival rates $ are 80% and 77%, respectively. Eighty-six patients (89%) received a single allograft and 11 (11%) children required retransplantation, one from an ABO-incompatible donor. Five were recipients of whole liver (20%), one child primarily received a reduced-size liver (17%), whereas 5 children were in the split liver group (8%).
The 6-month and 1-year actuarial patient survival rates $ of patients primarily transplanted with a split liver are 92% and 88%, respectively; for patients who received a reduced-size liver are 67% and 67%, respectively, and for patients transplanted with a whole liver are 79% and 79%, respectively.
For patients who received a split liver, actuarial survival rate based on UNOS status $ at the time of transplantation was determined. Six-month and 1-year patient survival rates clustered by UNOS status were 94% and 94%, 89% and 89%, and 80% and 30% for status 3, 2, and 1, respectively.