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No Child Left Behind: Liver Transplantation in Critically Ill Children
- Source :
- Journal of the American College of Surgeons. 224:671-677
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Background Advances in critical care prolong survival in children with liver failure, allowing more critically ill children to undergo orthotopic liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine survival in children who undergo OLT while receiving pre-OLT critical care. Study Design We analyzed 13,723 pediatric OLTs using the United Network for Organ Sharing (UNOS) database from 1987 to 2015, including 6,746 recipients in the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) era (2002 to 2015). There were 1,816 recipients (26.9%) admitted to the ICU at the time of transplantation. We also analyzed 354 pediatric OLT recipients at our center from 2002 to 2015, one of the largest institutional experiences. Sixty-five recipients (18.3%) were admitted to the ICU at the time of transplantation. Kaplan-Meier, volume threshold, and multivariable analyses were performed. Results Patient survival improved steadily over the study period, (66% 1-year survival in 1987 vs 92% in 2015; p Conclusions This analysis demonstrates that the use of advanced critical care in children and infants with liver failure is justified because OLT can be performed on the sickest children and acceptable outcomes achieved. It is an appropriate use of a scarce donor allograft in a child who would otherwise succumb to a terminal liver disease.
- Subjects :
- United Network for Organ Sharing
medicine.medical_specialty
business.industry
Critically ill
medicine.medical_treatment
Hazard ratio
Renal function
Liver transplantation
medicine.disease
Transplantation
03 medical and health sciences
Liver disease
surgical procedures, operative
0302 clinical medicine
030225 pediatrics
Medicine
030211 gastroenterology & hepatology
Surgery
business
Pediatric end-stage liver disease
Intensive care medicine
Subjects
Details
- ISSN :
- 10727515
- Volume :
- 224
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi...........e58e59e701ee0f6a4360d87467493a09