Health status of children alive 10 years after pediatric liver transplantation performed in the US and Canada: report of the studies of pediatric liver transplantation experience

J Pediatr. 2012 May;160(5):820-6.e3. doi: 10.1016/j.jpeds.2011.10.038. Epub 2011 Dec 20.

Abstract

Objectives: To determine clinical and health-related quality of life outcomes, and to derive an "ideal" composite profile of children alive 10 years after pediatric liver transplantation (LT) performed in the US and Canada.

Study design: This was a multicenter cross-sectional analysis characterizing patients enrolled in the Studies of Pediatric Liver Transplantation database registry who have survived >10 years from LT.

Results: A total of 167 10-year survivors were identified, all of whom received daily immunosuppression therapy. Comorbidities associated with the post-LT course included post-transplantation lymphoproliferative disease (in 5% of patients), renal dysfunction (9%), and impaired linear growth (23%). Health-related quality of life, as assessed by the PedsQL 4.0 Generic Core Scales, revealed lower patient self-reported total scale scores for 10-year survivors compared with matched healthy children (77.2±12.9 vs 84.9±11.7; P<.001). At 10 years post-LT, only 32% of patients achieved an ideal profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression-induced sequelae.

Conclusion: Success after pediatric LT has moved beyond patient survival. Availability of an ideal composite profile at follow-up provides opportunities for patients, families, and healthcare providers to identify broader sets of outcomes at earlier stages, ultimately contributing to improved outcomes after pediatric LT.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, American Recovery and Reinvestment Act
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Distribution
  • Child
  • Child Welfare
  • Child, Preschool
  • Cross-Sectional Studies
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Health Status*
  • Humans
  • Incidence
  • Infant
  • Liver Failure / diagnosis
  • Liver Failure / surgery
  • Liver Transplantation / immunology
  • Liver Transplantation / methods
  • Liver Transplantation / mortality*
  • Male
  • Ontario
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality
  • Quality of Life*
  • Sex Distribution
  • Survivors / statistics & numerical data*
  • Time Factors
  • Transplantation Immunology*
  • Treatment Outcome
  • United States