Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2018; 10(1): 62-72
Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.62
Predicting early outcomes of liver transplantation in young children: The EARLY study
Rashid Alobaidi, Natalie Anton, Dominic Cave, Elham Khodayari Moez, Ari R Joffe
Rashid Alobaidi, Natalie Anton, Dominic Cave, Ari R Joffe, Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta T6G 1C9, Canada
Elham Khodayari Moez, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2B7, Canada
Author contributions: Alobaidi R, Anton N, Cave D and Joffe AR contributed to conception and design of the study, interpretation of data and revision of the manuscript critically for intellectual content, and have read and approved the version to be published; Moez EK contributed to interpretation of data, confirmation of statistical analyses and revision of the manuscript critically for intellectual content, and has read and approved the version to be published; Joffe AR contributed to acquisition and interpretation of data, wrote the first draft of the manuscript, and had final approval of the version to be published; Alobaidi R contributed to acquisition and interpretation of data and revision of the manuscript critically for intellectual content, and had final approval of the version to be published; Joffe AR, Alobaidi R and Moez EK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; all authors participated sufficiently in the work to take public responsibility for the manuscript content.
Institutional review board statement: This study was approved by the University of Alberta Health Research Ethics Board (Pro00031805).
Informed consent statement: The need for written informed consent was waived for this retrospective chart review study by the Research Ethics Board.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: The dataset is available from the corresponding author at ari.joffe@ahs.ca upon reasonable request. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ari R Joffe, MD, Full Professor, Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta and Stollery Children’s Hospital, 4-546 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada. ari.joffe@ahs.ca
Telephone: +1-780-2485435 Fax: +1-888-7901283
Received: October 19, 2017
Peer-review started: October 26, 2017
First decision: December 1, 2017
Revised: December 20, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 27, 2018
Abstract
AIM

To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years.

METHODS

This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015. Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form. Associations between potential predictor variables and outcomes were determined using univariate and multiple logistic [odds ratio (OR); 95%CI] or linear (effect size, ES; 95%CI) regressions.

RESULTS

There were 65 children, of mean age 11.9 (SD 7.1) mo and weight 8.5 (2.1) kg, with biliary-atresia in 40 (62%), who had a living related donor [LRD; 29 (45%)], split/reduced [21 (32%)] or whole liver graft [15 (23%)]. Outcomes after liver transplant included: ventilator-days of 12.5 (14.1); pediatric intensive care unit mortality of 5 (8%); re-operation in 33 (51%), hepatic artery thrombosis (HAT) in 12 (19%), portal vein thrombosis (PVT) in 11 (17%), and any severe complication (HAT, PVT, bile leak, bowel perforation, intraabdominal infection, retransplant, or death) in 32 (49%) patients. Predictors of the prespecified primary outcomes on multiple regression were: (1) HAT: split/reduced (OR 0.06; 0.01, 0.76; P = 0.030) or LRD (OR 0.16; 0.03, 0.95; P = 0.044) vs whole liver graft; and (2) ventilator-days: surgeon (P < 0.05), lowest antithrombin (AT) postoperative day 2-5 (ES -0.24; -0.47, -0.02; P = 0.034), and split/reduced (ES -12.5; -21.8, -3.2; P = 0.009) vs whole-liver graft. Predictors of the pre-specified secondary outcomes on multiple regression were: (1) any thrombosis: LRD (OR 0.10; 0.01, 0.71; P = 0.021) or split/reduced (OR 0.10; 0.01, 0.85; P = 0.034) vs whole liver graft, and lowest AT postoperative day 2-5 (OR 0.93; 0.87, 0.99; P = 0.038); and (2) any severe complication: surgeon (P < 0.05), lowest AT postoperative day 2-5 (OR 0.92; 0.86-0.98; P = 0.016), and split/reduced (OR 0.06; 0.01, 0.78; P = 0.032) vs whole-liver graft.

CONCLUSION

In young children, whole liver graft and surgeon was associated with more complications, and higher AT postoperative day 2-5 was associated with fewer complications early after liver transplantation.

Keywords: Liver transplantation, Pediatric, Complications, Thrombosis, Antithrombin

Core tip: In a retrospective review of 65 consecutive children having had liver transplant at age less than 3-year-old, done at a single referral institution, earlier post-operative complications were independently statistically associated with whole liver graft (compared to split/reduced or living related graft), surgeon, and lower antithrombin levels day 2-5 postoperatively. The finding that lower antithrombin levels were associated with any thrombosis, any severe complication, and ventilator days is a novel finding that should be confirmed by others.