Prognostic factors for long-term actual patient survival after orthotopic liver transplantation in children

Background. Orthotopic liver transplantation has become the treatment of ch oice for children with end stage liver disease. Although results have impro ved the last decades, still a considerable number of children die after tra nsplantation. The aim of this study was to analyze long-term actual surviva l and to identify prognostic factors for such survival rates. Methods. A consecutive series of 68 children receiving transplants who had or could have had a follow-up of at feast 5 years was retrospectively analy zed. Actual survival and prognostic factors in relation to patient, donor, and operation related variables were assessed after multivariate analysis. Results. Actual 1-, 3-, and 5-year patient survival was 86%, 79%, and 73%, respectively. A high Child-Pugh (C-P) score or C-P class C, high donor age, high blood loss index, and retransplantation were predictive factors for a ctual patient survival. A high blood loss index was correlated with biliary atresia, low recipient age and weight, and with previous upper abdominal o perations, The duration of stay of the donor at the intensive care unit (IC U) was a predictive factor for retransplantation, Conclusions. Children with diseases eligible for liver transplantation shou ld be seen early in the course of their disease in a transplantation center . All possible measures should be taken during the transplantation procedur e to keep the blood loss at a minimum. Children with biliary atresia deserv e special attention in this respect. The choice of donors has implications for survival.