Background: Improved 1,5, & 10- year survival following Pediatric Liver Transplantation (LT) has been demonstrated. However 20 and 25-year patient and graft outcomes (including cause of death and re-transplantation indication) remain unknown in this patient population.

Aim: to describe 20 and 25-year patient and graft outcomes following pediatric LT.

Methods: The UNOS database was queried for all children <18-years at transplant who had received a single, deceased donor, liver-alone transplant (LT) between 1987 -1995. Patients lost to follow-up (FU) were checked against external sources for possible death. Kaplan Meier survival curves were generated.

Results: A total of 2061 patients had FU of 20-years (Group I), of which 708 (59.4%) had FU for 25-years (Group II). Of the entire group, 271 (13%) died, 322 (16%) underwent re-LT and 819 (40%) were lost to FU. In both groups, the majority were < 5ys at LT (59.4%,61.3%) with a mean age of 5.05+/- 5.54 and 4.69+/-5.18, equal male/female ratio and the majority received whole organs (90.8%, 97.7%). Common causes for re-LT in both groups included chronic rejection (42%, 40%), recurrent disease (14%, 11%) and biliary problems (10%, 9%); Common causes of death included infection (34, 29%), other/unknown (29%, 27%), graft failure (14%, 20%), and malignancy/PTLD (11%, 12%).

A significant decline in patient and graft survival across age groups over time was observed, with the best 20 and 25-year patient (87% CI 84%-89%, 80% CI 74%-84%) and graft survival (77% CI 74%-80%, 68% CI 62%-73%) in the age <5-year group, and the worst 20-year patient and graft survival in the 16-17-years age group (68% CI 60%-78%)(48% CI 38%-58%) respectfully.Conclusion: Pediatric LT recipients have a continuous and significant loss in both patient and graft survival over 20-25-years of FU, with infection being the most common cause of death and chronic rejection the most common indication for re-LT. Interestingly, recipients with the best long-term survival are those transplanted as infants. Further studies are needed to better define the reason(s) for these progressive declines.

CITATION INFORMATION: Andrews W, Gupta N, Ekong U. 20 and 25-Year Outcomes Following Pediatric Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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