Published online Mar 28, 2020. doi: 10.3748/wjg.v26.i12.1352
Peer-review started: November 24, 2019
First decision: December 30, 2019
Revised: February 17, 2020
Accepted: February 28, 2020
Article in press: February 28, 2020
Published online: March 28, 2020
Since the first successful pediatric living donor liver transplantation (LDLT) in 1989 by Strong, the procedure has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, and surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in mainland China are rare.
The purpose of this study was to provide information on the status of pediatric LDLT in Shanghai in recent years and to determine which of the perioperative management-related factors might impact survival rate in pediatric LDLT. These findings will help to optimize perioperative management in pediatric patients receiving LDLT in the future.
To summarize the status of pediatric LDLT in Shanghai in recent years and to investigate the impact of perioperative management-related factors on the survival rate in pediatric LDLT.
A retrospective observational study was conducted by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital. Cox regression analysis was used to identify independent predictive factors of patients’ overall survival.
The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95%CI: 2.16–14.14; P = 0.0004). Moreover, the pediatric end-stage liver disease (PELD) score, operation duration, and intensive care unit (ICU) length of stay were independent predictive factors of 1-year and 3-year patient survival.
In summary, our findings demonstrated that the annual caseload of pediatric LDLT has been growing rapidly and recipients have achieved excellent outcomes in Shanghai with a 2-year patient survival rate of 89.34%. The PELD score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.
The present retrospective study demonstrates that the PELD score, operation duration, and ICU length of stay are independent predictive factors of in-hospital patient survival as well as of 1- and 3-year patient survival, and suggests that prospective trials exploring the effects of these factors on pediatric LDLT patient survival are warranted.