TY - JOUR
T1 - Outcomes for children after second liver transplantations are similar to those after first transplantations
T2 - a binational registry analysis
AU - Jeffrey, Angus W.
AU - Jeffrey, Gary P.
AU - Stormon, Michael
AU - Thomas, Gordon
AU - O'Loughlin, Edward
AU - Shun, Albert
AU - Hardikar, Winita
AU - Jones, Robert
AU - McCall, John
AU - Evans, Helen
AU - Starkey, Graham
AU - Hodgkinson, Peter
AU - Ee, Looi C.
AU - Moore, David
AU - Mews, Catherine
AU - McCaughan, Geoff W.
AU - Angus, Peter W.
AU - Wigg, Alan J.
AU - Crawford, Michael
AU - Fawcett, Jonathan
PY - 2020/11
Y1 - 2020/11
N2 - Objective: To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986–2017; to determine the factors that influence survival. Design: Retrospective cohort analysis (registry data). Setting, participants: Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986–2017, in all four paediatric and six adult liver transplantation centres in the two countries. Main outcome measures: Graft and patient survival at one, 5, 10 and 15 years. Results: 142 liver retransplantations were undertaken in children (59 during 1986–2000, 83 during 2001–2017). Kaplan–Meier survival analysis indicated that survival was significantly greater during 2001–2017 than 1986–2000 (P < 0.001). During 2001–2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03–1.4 years) during 1986–2000, and 1.8 years (IQR, 0.1–6.8 years) during 2001–2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001–2017 (35 of 83, 42%) than 1986–2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation. Conclusion: Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.
AB - Objective: To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986–2017; to determine the factors that influence survival. Design: Retrospective cohort analysis (registry data). Setting, participants: Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986–2017, in all four paediatric and six adult liver transplantation centres in the two countries. Main outcome measures: Graft and patient survival at one, 5, 10 and 15 years. Results: 142 liver retransplantations were undertaken in children (59 during 1986–2000, 83 during 2001–2017). Kaplan–Meier survival analysis indicated that survival was significantly greater during 2001–2017 than 1986–2000 (P < 0.001). During 2001–2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03–1.4 years) during 1986–2000, and 1.8 years (IQR, 0.1–6.8 years) during 2001–2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001–2017 (35 of 83, 42%) than 1986–2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation. Conclusion: Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.
KW - Ethics
KW - Liver diseases
KW - Liver transplantation
KW - Tissue and organ procurement
UR - http://www.scopus.com/inward/record.url?scp=85092052440&partnerID=8YFLogxK
U2 - 10.5694/mja2.50802
DO - 10.5694/mja2.50802
M3 - Article
C2 - 33015834
AN - SCOPUS:85092052440
SN - 0025-729X
VL - 213
SP - 464
EP - 470
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 10
ER -