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Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis
Author(s) -
Jeffrey Angus W,
Jeffrey Gary P,
Stormon Michael,
Thomas Gordon,
O'Loughlin Edward,
Shun Albert,
Hardikar Winita,
Jones Robert,
McCall John,
Evans Helen,
Starkey Graham,
Hodgkinson Peter,
Ee Looi C,
Moore David,
Mews Catherine,
McCaughan Geoff W,
Angus Peter W,
Wigg Alan J,
Crawford Michael,
Fawcett Jonathan
Publication year - 2020
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50802
Subject(s) - medicine , liver transplantation , survival analysis , surgery , cohort , retrospective cohort study , transplantation , overall survival , pediatrics
Objective To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986–2017; to determine the factors that influence survival. Design Retrospective cohort analysis (registry data). Setting, participants Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986–2017, in all four paediatric and six adult liver transplantation centres in the two countries. Main outcome measures Graft and patient survival at one, 5, 10 and 15 years. Results 142 liver retransplantations were undertaken in children (59 during 1986–2000, 83 during 2001–2017). Kaplan–Meier survival analysis indicated that survival was significantly greater during 2001–2017 than 1986–2000 ( P < 0.001). During 2001–2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03–1.4 years) during 1986–2000, and 1.8 years (IQR, 0.1–6.8 years) during 2001–2017 ( P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001–2017 (35 of 83, 42%) than 1986–2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation. Conclusion Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.