CAUSES OF LATE MORTALITY IN PEDIATRIC LIVER-TRANSPLANT RECIPIENTS

Objective This study was undertaken to review the incidence and causes of death in children who have survived long-term (more than 1 year) a fter liver transplantation (LT). Summary Background Data No studies of the causes of late mortality in pediatric LT recipients are currently available in the literature. Methods The study group consists of 212 pediatric patients who survived more than 1 year after LT. Twenty-thre e of these patients subsequently died (mean follow-up = 5.3 yr). Hospi tal records, office charts, and autopsy records were reviewed retrospe ctively to identify the causes of death. The patients who died were fu rther evaluated by age, gender, length of survival, primary diagnosis, immunosuppression, and retransplantation. Results The most common cau se of death was graft failure, followed closely by infection. In patie nts dying from graft failure, eight of the nine patients underwent ret ransplantation and no child survived more than three liver transplants . Overwhelming infections occurred suddenly in eight children who had been previously healthy. Noncompliance was the third most common cause of death, primarily in older children. One child died from a posttran splant lymphoproliferative disorder (PTLD). Actuarial survival at 10 y ears is 83.7% (based on 100% survival at 1 year). There was no differe nce in survival based on primary disease. Retransplantation was far mo re prevalent in the nonsurvivors (47.8%) compared with survivors (13.7 %) (p < 0.05). There were no significant differences in survival based on age, gender, or immunosuppression. Conclusions Late mortality in c hildren continues to be directly related to complications of LT and im munosuppression, even after the first year of transplantation. This is in contrast to adult liver transplant recipients, where approximately 50% of late deaths were related to LT and the remainder were because of unrelated illnesses.