Fulminant Hepatic Failure in Children: Superior and Durable Outcomes with Liver Transplantation Over 25 Years at a Single Center
*Douglas G Farmer, *Robert S Venick, *Sue V McDiarmid, John Duffy, *Omar Kattan, *Johnny Hong, Jorge Vargas, *Hasan Yersiz, Ronald W Busuttil
David Geffen School of Medicine at UCLA, Los Angeles, CA
OBJECTIVE(S): Death occurs in half of all children with fulminant hepatic failure (FHF). While pediatric liver transplantation (PLTx) is potentially life-saving, there are only a few published series with limited experience. The aim was to examine predictors of survival after PLTx for FHF.
METHODS: All FHF PLTx between 1984-2008 were analyzed from a prospectively maintained database using 36 demographic, laboratory, and operative variables. Unique calculated variables included Creatinine Clearance (cCrCl) and Pediatric End-Stage Liver Disease score (PELD). Study end-points were patient and graft survival. Median followup was 97 mo. Statistical analysis involved the log rank test and cox proportional hazards model.
RESULTS: 118 children underwent 150 PLTx. Cryptogenic was the primary etiology (68%) and 29% were age <24mo. The Table shows the significant (p<0.05) univariate and multivariate predictors of survival. While overall 5- and 10-yr survival was 73% and 68% (GRAFT) and 78% and 74% (PATIENT), these were markedly worse (p<0.05) when a combination of risk-factors were present.
CONCLUSIONS: This data from a large, single-center experience demonstrates that PLTx is the treatment of choice for FHF and results in durable survival. Analysis revealed 5 novel outcome predictors. Young children with rapid onset ALF are a high-risk subpopulation. Unique to this study, cCrCl and PELD accurately predicted the end-points. This analysis identifies patient subpopulations requiring early aggressive intervention with PLTx.
|Variables Affecting Patient Survival||Variables Affecting Graft Survival|
|Univariate Analysis Results||non-caucasian RACE|
|Multivariate Analysis Results||cCrCl<60|
|Survival with All multivariate Variables||25%||43%|
|*time from onset of jaundice to encephalopathy||#Warm Ischemia time|