Outcomes following liver transplantation in young infants: Data from the SPLIT registry. Issue 3 (5th September 2020) - Jain, Ajay K.
Abstract : Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre‐, intra‐, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0‐<3, 3‐<6, 6‐<12 months, and 1‐<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5‐10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times ( P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1‐3.9] and 16.7 [6.8‐29.7] mg/dL) and those <5 kg (2.6 [1.8‐3.4] and 13.5 [3.0‐28.4] mg/dL). A pediatric end ‐stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes. Abstract : Among infants with liver failure, those who are 0– <3 months of age and those <5kg need more intensive care with lower survival and higher complications, but timely liver transplantation remains the best hope for long‐term survival.