1. In approximately 14,000 pediatric patients across Europe who received a liver transplant between 1968-2017, the overall survival rate improved from 74% prior to 2000, to 85% after 2010, with the highest rate of survival in those who survived the first year after transplant (97%).

2. Over time, a higher percentage of liver transplants were performed in patients <6 years of age, with lower survival rates in patients <1 year of age.

Evidence Rating Level: 2 (Good)

Study Rundown: Outcomes in pediatric liver transplantations have improved over the course of the last few decades. This study aimed to evaluate patient characteristics, indications for pediatric liver transplant, and outcomes in a larger cohort of approximately 14,500 patients who underwent pediatric liver transplant in Europe prior to 18 years of age. Data were grouped into 3 time periods; prior to 2000 (i.e., during which time pediatric liver transplant was experimental), between 2000-2009 (i.e., during surgical innovation), and post 2010 (i.e., focus on improving long-term outcomes). Overall, the survival rates improved over time, with current 5-year patient survival rates of 86% and 97% for those who survived 1 year post-transplant. Children >1 year of age had the best long-term outcomes, with less favorable 5-year survival in those <1 year of age (81%). Since 2010, there has been no association between survival and the number of transplants performed by each site. This study provides large-scale data that multiple pediatric outcomes after liver transplant have improved over the past half-century, with decreased morbidity and mortality. A future research focus should be investigation of causes of increased mortality in those <1 year of age.

Click to read the study in PEDIATRICS

Relevant Reading: Improving patient outcomes following pediatric liver transplant: Current perspectives

In-Depth [retrospective cohort]: Between 1968-2017, 16,641 pediatric liver transplants were performed on 14,515 children at 133 centers across Europe, through the European Liver Transplant Registry (ELTR). The main indications for transplant included congenital biliary diseases (44%), of which biliary atresia was most common (39%), followed by metabolic diseases (18%). The proportion of children receiving a transplant <7 years of age increased to 66% since 2010, compared to 58% before 2000. Survival rates improved over time, from 74% before 2000, to 83% between 2000-2009, and 85% since 2010 (p<0.0001). Since 2010, 5-year patient survival was 86%, and higher in children who survived for >1 year after transplant (97%). There were decreased survival rates at low-volume centers (i.e., <5 pediatric liver transplants per year, p<0.0001), however this association became non-significant from 2010 onward. Obesity was significantly negatively correlated with survival outcomes (p=0.03). The most common cause of death was due to infection across all time periods.

Image: PD

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