McDiarmid et al identified various factors affecting the outcome following liver transplant in a pediatric patient. These can help to identify a patient who may benefit from more aggressive management or an alternative therapy. The authors are from the University of California at Los Angeles, the Emmes Corporation (Rockville, Md), the University of Chicago and Children's Hospital of Pittsburgh.


Patient selection: pediatric patient undergoing liver transplant


Outcomes: patient and/or graft survival at 6 months (period of greatest patient and transplant loss)


Factors with negative impact on outcomes:

(1) The patient is in the ICU and intubated prior to the liver transplant.

(2) The patient required reoperation after the transplant for any reason.

(3) The patient develops vascular thromboses (hepatic artery, portal vein).

(4) The patient becomes septic.

(5) The patient develops a bowel perforation.

(6) The patient requires retransplantation.


Additional factors having a negative impact on outcomes:

(1) A split graft was used for transplant.

(2) Cyclosporine was used for primary immunosuppression.

(3) Surgery performed at a center or by a surgical team with less expertise.


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