Children do well 5 years after liver transplant

NEW YORK (Reuters Health) - New research indicates that most children who are 5-year survivors of liver transplantation have good graft function; however, chronic medical conditions and complications affecting other organs are common in this patient population.

“The success of liver transplantation in children is defined by more than just excellent survival rates. Better understanding of the long-term medical considerations is of critical importance in pediatric liver transplant recipients, who by nature of their young age face a greater cumulative burden of life-long immunosuppression,” Dr. Vicky Lee Ng and co-researchers emphasize in their report in the journal Pediatrics.

Liver transplantation has been the standard of care for life-threatening liver diseases for more than two decades, yet multicenter data regarding the long-term outcomes have been lacking, Ng, from the University of Toronto, and associates point out.

The current investigation included 461 patients who survived longer than 5 years after undergoing a liver transplant at 1 of 45 pediatric centers across North America between 1996 and 2001.

Overall, 88 percent of the patients survived with their first liver transplant, while 12 percent required one or two additional attempts.

Most patients had a functional liver at their 5-year clinic assessment, the report indicates. For immunosuppressive therapy, given to prevent organ rejection, most patients - 97 percent - received a calcineurin inhibitor and 25 percent were prescribed prednisone.

The risk of having an episode of sudden cellular rejection within 5 years was 60 percent. Gradual continuous, or chronic, rejection also occurred in 5 percent of the patients, the authors note.

Six percent of the children developed posttransplant lymphoproliferative disease, an increased production of lymphocytes, which is normally seen as a response to infection. Thirteen percent of the subjects had signs of possible kidney disease.

After accounting for the effects of age and gender, 12 percent of the subjects had a weight that was above the 95th percentile and 29 percent had a height below the 10th percentile.

“This study emphasizes the need for a collaborative partnership between primary care practitioners and pediatric healthcare providers both beyond and within transplant centers to further improve outcomes for pediatric liver transplant recipients,” the researchers conclude.

SOURCE: Pediatrics, December 2008.

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