Incidence, impact on survival, and risk factors for multi-organ system failure in children following liver transplantation

Liver transplantation (LTx) in children currently offers longterm survival rates of more than 80%. Many causes for Tx failure have been identified. Ho wever, the incidence and impact of multi-organ system failure (MOSF) are. t o date, unknown. Therefore, in this study the role of MOSF after LTx in chi ldren was investigated with regard to outcome. The data of 114 children (53 girls, 61 boys: median age 4.3 yr) after first LTx were evaluated retrospe ctively. The definition of MOSF, as used by Wilkinson et al. [Crit Care Med 1986: 14: 271-274], was modified with regard to age-adjusted values. The i nfluence of MOSF on patient survival was investigated by Kaplan-Meier analy sis and multivariate regression analysis. Thirty-one of 114 children with o rthotopic LTx developed MOSF (involving two or more organs), In total, 18 c hildren died (15.8%) during the hospitalization; 16 of these had MOSF. Mort ality related to two-organ failure was 29.4% (n=5), to three-organ failure 78% (n=7), and to four-organ failure 80%, (n=4). The highest mortality rate s were observed in children with central nervous system (CNS) and cardiovas cular failure, leading to a decreased probability of survival of 0.40 (p <0 .0001). Multi-variate analysis showed that CNS and cardiovascular failure w ere the most important risk factors for survival (p <0.0001 and 0.056, resp ectively). Respiratory and renal failure, in univariate analysis, were sign ificant contributors to poor survival, but had no statistically significant influence on outcome in multivariate analysis. Bone marrow insufficiency w as found to have no influence on survival in either analysis. In multivaria te analysis. the risk of development of MOSF was significantly increased by high numbers of transfused units of fresh-frozen plasma (FFP), the absence of rejection episodes, or a high bilirubin level prior to Tx. Hence, MOSF is a major factor contributing to the death of children early after LTx. CN S and cardiovascular failure carried the highest risk for a poor outcome. O ther risk factors associated with the development of MOSF were: numbers of transfused units of FFP, absence of rejection episodes, and a high pre-Tx b ilirubin level.