Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study

Table 1 Donors and recipients demographics

Demographics	ALF (n = 37), %	ESCLD (n = 195), %	P value
Donor demographics
Sex
Male	45.7	46.9	0.902
Female	54.3	53.1
Weight, kg	66.2 (8–90)	65.8 (10–98)	0.912
Age, yr	35.2 (0.9–65)	29 (1–66)	0.039
Type of liver graft
Whole liver	14 (37.8)	38 (19.7)	0.016
Variant graft including split, reduced, living donor	23 (62.2)	155 (80.3)
Recipient demographics
Sex
Male	16 (43.2)	102 (52.3)	0.312
Female	21 (56.8)	93 (47.7)
Age at transplant, yr	8 (0.1–16.7)	5.4 (0.3–17.2)	0.031
Weight, kg	31 (2.7–66.5)	21 (4.7–89)	0.011
Etiology of liver disease
Alagille's syndrome	0 (0)	12 (6.2)	0.222
Alpha-1-AT deficiency	0 (0)	15 (7.7)	0.138
Autoimmune	4 (10.8)	13 (6.7)	0.487
Biliary atresia	0 (0)	92 (47.2)	< 0.001
Biliary cirrhosis	0 (0)	2 (1.0)	1.000
CF liver disease	0 (0)	13 (6.7)	0.232
Drug induced	2 (5.4)	0 (0)	0.025
Hepatitis A	2 (5.4)	0 (0)	0.025
HSV	2 (5.4)	0 (0)	0.025
Seronegative hepatitis	17 (45.9)	0 (0)	< 0.001
PFIC	0 (0)	29 (14.9)	0.006
Post-liver resection	2 (5.4)	0 (0)	0.025
PSC	0 (0)	8 (4.1)	0.361
Others	8 (21.6)	11 (5.6)	0.004
Location of the recipient when the graft is available
Home	0 (0)	137 (71.4)	< 0.001
Hospital	15 (40.5)	47 (24.5)	0.044
PICU not ventilated	7 (18.9)	5 (2.6)	0.001
PICU ventilated	15 (40.5)	3 (1.6)	< 0.001

ALF: Acute liver failure; CF: Cystic fibrosis; ESCLD: End-stage chronic liver disease; HSV: Herpes simplex virus; PFIC: Progressive familial intrahepatic cholestasis; PICU: Pediatric intensive care unit; PSC: Primary sclerosing cholangitis.

Table 2 Post-transplant outcomes

Outcome	ALF among n = 37, n (%)	ESCLD among n = 195, n (%)	P value
Vascular complications
AV malformation post-liver biopsy	0 (0)	1 (0.5)	1.000
Retroperitoneal hematoma, femoral vein bypass cannula	0 (0)	1 (0.5)	1.000
HAS	2 (5.4)	13 (6.7)	1.000
PVS	0 (0)	14 (7.2)	0.134
HAT	1 (2.7)	10 (5.1)	1.000
PVT	1 (2.7)	7 (3.6)	1.000
HVS	1 (2.7)	0 (0)	0.159
Biliary complications
CHD sludge	0 (0)	2 (1)	1.000
Biliary stricture	3 (8.1)	21 (10.8)	0.775
Bile leak	0 (0)	23 (11.8)	0.031
Cause of graft loss	n = 5	n = 27
HAT	0 (0)	9 (33.3)	0.288
PNF	2 (40)	5 (18.5)	0.296
Chronic rejection	3 (60)	6 (22.2)	0.121
Biliary tract complications	0 (0)	7 (25.9)	0.560
Cause of death	n = 9	n = 17
Unknown	0 (0)	5 (29.4)	0.129
Cardiopulmonary	3 (33.3)	1 (5.9)	0.104
Cerebral oedema	1 (11.1)	0 (0)	0.346
Fungal infection	1 (11.1)	0 (0)	0.346
Gastrointestinal	0 (0)	1 (5.9)	1.000
Intracranial hemorrhage	1 (11.1)	0 (0)	0.346
Liver failure	1 (11.1)	4 (23.5)	0.628
Recurrence of disease	0 (0)	1 (5.9)	1.000
Sepsis	2 (22.2)	5 (29.4)	1.000

ALF: Acute liver failure; AV: Arteriovenous; CHD: Common hepatic duct; ESCLD: End-stage chronic liver disease; HAS: Hepatic artery stenosis; HAT: Hepatic artery thrombosis; HVS: Hepatic vein stenosis; PNF: Primary non-function; PVS: Portal vein stenosis; PVT: Portal vein thrombosis.

Table 3 Survival among category groups- 1-, 5-, 10-yr and end of study for patients and grafts

Survival outcome	Mean	%1 yr	%5 yr	%10 yr	%End of study	Log rank
						χ2	P value
Patient survival
ALF	14.86	78.3	78.3	78.3	69.6	7.370	0.007
ESCLD	17.71	97.9	93.9	89.4	85.0
Graft survival
ALF	12.46	75.6	72.4	66.9	47.8	2.426	0.119
ESCLD	14.46	90.7	82.9	77.3	56.8

ALF: Acute liver failure; ESCLD: End-stage chronic liver disease.