Korean J Transplant.  2022 Nov;36(Supple 1):S283. 10.4285/ATW2022.F-4246.

Long-term survival outcome beyond the 1st year of pediatric acute liver failure after liver transplantation compared with biliary atresia: a large-volume living donor liver transplantation single-center study

• Lee S
• Yi NJ
• Hong SY
• Hong SK
• Choi Y
• Kim HY
• Moon JS
• Yang SM
• Lee KW
• Suh KS

• KMID: 2535510
• DOI: http://doi.org/10.4285/ATW2022.F-4246

Abstract

Background
Pediatric acute liver failure (PALF) is the second most common cause for liver transplantation (LT) in children, but its outcomes are the worst. The purpose of this study is to compare the long-term outcomes of PALF to biliary atresia (BA) in liv-ing donor LT-dominant country.
Methods
From 2000 to 2015, patients who received primary LT for BA or PALF were analyzed, retrospectively. Survival outcomes and surgical complications between the two groups are compared. Univariate and multivariate analyses of patient factors were performed to identify risk factors associated with patient survival.
Results
One hundred and fifty-six patients received primary LT. Patients in the PALF group were older (6.2 years old vs. 2.9 years old) with higher body weight (25.7 kg vs. 13.8 kg, P<0.01). PALF group also showed a higher rate of hepatic artery complication (13.9% vs. 0.8%, P<0.01). In the comparison of 1-year survival rates, the PALF group showed lower survival than the BA group (77.8% vs. 96.7%, P<0.01). Analyzing patients who survived beyond the 1st year of transplantation, there was no significant differ-ence in the 5-year patient survival rates between the two groups (96.4% in PALF group vs. 99.1% in BA group, P=0.548). The most common causes of death were graft failure and infection. Hepatic artery complication and need for postoperative renal replacement therapy were factors associated with worse 5-year survival (P <0.01 and P=0.029, respectively).
Conclusions
In conclusion, the overall survival of the PALF is lower than the survival of BA patients. However, there was no difference in the survival between two groups who survived the 1st year LT. We have identified hepatic artery complication and need for posttransplant renal replacement therapy as poor prognostic factors. Children with associated factors should receive more attentive care and follow up after LT as liver failure can recur.