PTU-061 Outcomes of paediatric liver transplant recipients following transition from paediatric to adult healthcare services

Abstract

PURPOSE: Following the success of paediatric transplantation, many survivors undergo transition from paediatric to adult healthcare services. The outcome of liver transplant patients who undergo transition remains unclear. Aim: to examine the patient and graft survival of liver transplant patients post transfer to adult healthcare. METHOD: Single-centre retrospective study of 85 liver transplant recipients who underwent transition from paediatric (Birmingham Children's Hospital) to adult (Queen Elizabeth Hospital Liver Unit Birmingham) healthcare services between 2001 and 2011 (median follow-up time from transition 4.1 (range 0.2-10.7) years). RESULTS: During the 10 year period, there were 48 (56.5%) males and 37 (43.5%) females. The median age at time of transplant was 8.4 (range 0.6-17.9) years. The indications for transplantation were: biliary atresia (27%), Wilson's (14%), other acute liver failure (12%), cystic fibrosis (9%), autoimmune hepatitis (8%), cryptogenic cirrhosis (5%), oxalosis (5%), other (20%). At transition, the median age of the patients was 18.9 (range 16.6-23.1) years. 84.7% of patients had one graft, 12.9% had two and 2.4% had three. Immunosuppression at transition was calcineurin inhibitor (CNI) monotherapy in 38.2%, CNI combination in 20.6%, and CNI free regimen in 41.2%. Following transition, the estimated 1-, 5- and 10-year patient survival was 98.6%, 96.8% and 91.4%, respectively, and the estimated 1-, 5- and 10-year graft survival was 98.6%, 95.0% and 89.4%. 6 grafts were lost post transfer; 2 were re-transplanted due to chronic rejection (CR) at 22 and 54m post transfer; 4 deaths: median (range): 19m (7-75); causes of death PTLD; CR: sepsis; fibrosis and portal obstruction. CONCLUSION: These results demonstrate that graft loss is approximately 10% in this group of paediatric liver transplant recipients within 10 years of transfer which raises issues about the management of graft loss and transition with adult services.