Introduction: Liver transplantation is an established treatment for end-stage liver disease in both adults and children. However, pediatric patients exhibit unique considerations due to a wide range of clinical presentations, anthropometric variations, and etiologies that contribute to end-stage liver failure. Accurately predicting post-transplant outcomes in children remains challenging. This study aimed to identify independent risk factors for early mortality following liver transplantation in pediatric recipients.
Methods: A retrospective cohort study was conducted using clinical data from 701 patients under 18 years who underwent liver transplantation at a single large transplant center between January 2017 and March 2023. Uni- and multivariate regression analyses were performed to identify preoperative risk factors associated with 90-day post-transplant mortality. Survival outcomes were also evaluated.
Results: The 90-day, 3-year, and 5-year overall survival rates were 92.9%, 90%, and 89.5% respectively. On univariate analysis, several preoperative factors showed a significant association with 90-day mortality, including age 3-5 years, retransplantation, diagnosis of acute liver failure, severity scores PELD/MELD ≥23 or ≥40, and critical pre-transplant clinical status requiring intensive care unit admission. In multivariate analysis, independent predictors of early mortality included body weight ≤6kg (hazard ratio HR 2.79, 95% CI 1.19-6.53, p=0.02), retransplantation (HR 2.79, 95% CI 1.19-6.53, p=0.02), critical preoperative condition (HR 2.79, 95% CI 1.19-6.53, p=0.02), and PELD/MELD score ≥40 (HR 2.8, 95% CI 0.98-8.06, p=0.05).
Conclusion: Several modifiable and non-modifiable risk factors for early mortality following pediatric liver transplantation were identified. Children with extremely low body weight, prior transplant failure, critical pre-transplant status, or severe liver disease severity face significantly higher mortality risk. These findings provide valuable insight to guide patient selection and preoperative optimization efforts to improve post-transplant outcomes in high-risk pediatric recipients. Further refinement of predictive models tailored specifically for children is warranted.