GRAFT STATUS TEN YEARS AFTER PEDIATRIC LIVER TRANSPLANTATION

Y Avitzur^1,2, M Cantos, E De-Luca¹, A Fecteau^1,3, C Jimenez-Rivera^1,2, E Roberts^1,2, M Zachos^1,2, NL Jones^1,2, D Grant^1,4, VL Ng^1,2

¹PAMOT Program, ²Division of GI and Nutrition, ³Division of Pediatric General Surgery, The Hospital for Sick Children, and ⁴MOTU Program, Toronto General Hospital, Toronto, Ontario

Short term outcome after pediatric liver transplantation is well known. However, graft status of children alive at ten or more years after liver transplantation is less well characterized. The aim of this study was to assess the graft status of this group.
METHODS: Retrospective chart and database review of all children who underwent liver transplantation before October 1992, and ten years later were still followed at the Hospital for Sick Children (n=32). Measures of graft outcome were identified on the 10th year anniversary
RESULTS: Forty liver transplantations were performed in the study group. Six (18%) and 2 (6%) patients required a second and third transplant respectively, primarily for hepatic artery thrombosis and its complications (n=4), or chronic rejection (n=2). Surgical complications were uncommon after the first year post transplantation and included bile duct stricture (n=3) or portal vein stenosis/calcification (n=3). On the 10th year anniversary, liver synthetic function was normal in all patients and liver enzyme levels were normal in 20 (63%) patients. The cumulative annual rate of acute liver rejections declined from 1.44 rejections/patient/year in the first year to 0.32 by year 10. Thirteen episodes of steroid resistant acute rejection occurred in 8 patients and all responded to OKT-3 treatment. Only 2 (15%) episodes occurred more than six months post operatively. Eight patients (25%) developed chronic liver rejection as assessed by histopathology. Thirty (94%) patients remain on immunosuppressive therapy. The majority (66%) of these patients are maintained on monotherapy with either cyclosporin in 24 (80%) patients (mean trough levels 115.5±64.3 mg/L) or tacrolimus in 5 (16%) patients. Nine of the ten year survivors continue on low dose steroids.
CONCLUSIONS: Children who are long term survivors of liver transplant maintain good graft function 10 years postoperatively, although chronic rejection remains significant obstacle for better graft outcome.