Liver function, paraclinical tests, and mortality risk factors in pediatric liver transplant candidates

Abstract

Liver transplantation has become a well-recognized transplant modality for children with end-stage liver disease. The first indicator to evaluate its efficiency is mortality rate. The aim of this study is to evaluate the complications and mortality of liver disease in children waiting for transplantation and understanding the risk factors that predict liver transplant waiting list death. This is a single-center prospective cohort study of all patient ≤18 years of age with chronic liver disease listed for liver transplantation. We analyzed medical records of 130 children for mortality risk factor. There were 52.3 % boys and 47.7 % girls with mean age of 8.6 ± 6.1 year (range, 3 months–18 year). The most common causes of cirrhosis were biliary atresia (21.5 %). The most common complication while awaiting transplantation was failure to thrive (76.2 %). Up to end of study, 20 patients (15.4 %) died without transplantation, 22 (16.9 %) of them transplanted, and 88 (67.7 %) of patients were alive while waiting for a liver transplantation. Mortality rate and transplantation ratio were 15.4 and 16.9 % with survival time waiting list 67.7 %. Factors which significantly associated with waiting list mortality included encephalopathy (p = 0.006), child score ≥10 (p = 0.036), model for end-stage liver disease (MELD) score ≥20 (p = 0.002), gastrointestinal bleeding (p = 0.004), Na (p = 0.046), and international normalized ratio (INR) (p = 0.018). A pediatric risk factor = (0.715 × Encephalopathy) + (0.152 × INR) − (0.022 × Na) was created. It had 90-day survival time 76.5 % for low risk group and 40.6 % for high risk group (p = 0.001) with ROC curve area 0.7 (95 % CI 0.599–0.796). The pediatric risk score such as MELD predicts the risk of liver transplantation waiting list mortality. Use of such scores in organ allocation in Iranian liver transplant unit may result in reduced waiting list mortality.