Pediatric liver transplantation and retransplantation

1. Pediatric Liver Retransplantation:Pediatric Liver Retransplantation:
Outcomes and aOutcomes and a
Prognostic Scoring ToolPrognostic Scoring Tool
Adam Davis, Philip Rosenthal,Adam Davis, Philip Rosenthal, and Davidand David
GliddenGlidden
Departments of Pediatrics, Surgery, andDepartments of Pediatrics, Surgery, and
Epidemiology and Biostatistics,Epidemiology and Biostatistics,
University of California at San Francisco,University of California at San Francisco,
San Francisco, CASan Francisco, CA

2. Prognostic Scoring ToolPrognostic Scoring Tool
• Can modestly discriminate between
those children at high risk and those
children at low risk of poor outcome
after liver retransplantation

3. RetransplantationRetransplantation
Prognostic ScoringPrognostic Scoring
• Only first retransplants that occurred prior
to the subject’s 18th birthday and 2nd
Tx
before age of 28 were included
• Randomly divided into 2 groups
• Two-thirds were placed in the modeling
group, which was used to develop the
scoring system,
• One-third was placed in the validation
group, which was used to validate the
scoring system.

4. Modeling GroupModeling Group
• Clinical variables at the time of
retransplantation
• Chose the variables to include by
examining their P values in the univariate
analyses
• Variables stayed in the model if their P
value or the P value of 1 of their
categories was less than 0.3.
• In a Cox model, each patient is given a
risk score.

5. Validation GroupValidation Group
• Stratified into 3 categories by
prognostic score: high risk, medium
risk,and low risk.
• A univariate Cox proportional
hazards model and a Kaplan-Meier
survival nalysis were performed by
prognostic score risk groups.

6. RESULTSRESULTS
• Transplant-free survival was significantly better
after the initial liver transplant than with
retransplantation.
• Patients undergoing their first retransplantations
were 1.9 times more likely to die or be
retransplanted than those undergoing primary
liver transplantation.
• The hazard ratio (HR) continued to increase with
each successive retransplant
• Transplant-free survival for primary transplants
at 10 years was similar to transplant-free survival
for first retransplants at 6 months (65%).

9. Results……Results……No significant differences existed between the characteristics of
the modeling group (n 740) and those of the validation group (n 390).
In Univariate Analysis:
Significantly protective factors:
Older age,
More recent era of transplantation,
Chronic rejection as a contributor to graft failure,
Prolonged wait-list time,
Retransplant more than 5 years since the initial transplant
Significant risk factor:
An original diagnosis of neonatal cholestasis,
Familial cholestasis,
Paucity of ducts,
Congenital abnormalities,
Total parenteral nutrition,
Cholestasis
Being on life support at the time of retransplantation
Receiving a split liver graft.

11. In Multivariate analysis:
Significant factors:
Being originally diagnosed with neonatal cholestasis,
Familial cholestasis,
Paucity of ducts,
Congenital abnormalities,
Being on life support at the time of retransplantation
Protective Factors:
Having a retransplant during the most recent era of transplant
Being at least 5 years old at the time of retransplantation