FACTORS AFFECTING SURVIVAL AFTER ORTHOTOPIC LIVER-TRANSPLANTATION IN INFANTS

The technical and medical management of small infants requiring orthot opic liver transplantation remains a challenge. The present study exam ined 117 orthotopic liver transplantations performed in 101 infants fr om <1 to 23 months of age between March 1988 and February 1995 to dete rmine factors that influence patient and graft outcome. Factors analyz ed included etiology of liver disease, recipient and donor age and wei ght, United Network for Organ Sharing (UNOS) status, retransplantation , ABO-compatibility, full-size (FS) versus reduced-size grafts, vascul ar thrombosis CVT), including hepatic artery and portal vein (PVT), an d the presence of lymphoproliferative disease (LPD). UNOS status 1, fu lminant hepatic failure, and the development of Epstein-Barr virus-ass ociated LPD were each associated with 10-20% lower patient and graft s urvival rates. Of 101 infants, 11 (11%) developed LPD with an associat ed 36% mortality. VT occurred in 10 (9 hepatic artery and 1 portal vei n) of 117 orthotopic liver transplantations (9%), all less than 1 year of age, and was associated with significantly poorer 1-year (50% vs. 85% no VT, P<0.01) and 5-year patient survival rates (50% vs. 83% no V T, P<0.01). One-year graft survival rates for FS grafts in recipients <12 months versus 12-23 months were 67% vs. 94% (P<0.01); the patient survival rate was also significantly lower in FS graft recipients <12 months (76% vs. 100%, P<0.05). Recipients <5 months of age had the wor st survival rates: 1-year and 5-year patient survival rates were 65% a nd 46% for recipients 0-4 months (n=17) versus 82% and 82% for recipie nts 5-11 months (n=56), and 93% and 93% for recipients age 12-23 month s (n=28; P<0.05). In summary, factors associated with reduced survival rates include recipient age <5 months, recipient age <12 months who r eceived FS grafts, development of VT and donor weight <6 kg. There was a trend for UNOS status 1, fulminant hepatic failure, and presence of LPD to be associated with reduced survival rates.