Preoperative Comorbidity and Mortality in Pediatric Liver Transplantation Recipients: A Population-Based Cohort Study

OBJECTIVE: The purpose of this large, population-based study was to investigate preoperative comorbidities as risk factors of mortality in pediatric liver transplant recipients. METHODS: A total of 2,938 patients who underwent liver transplantation (LT) surgery from 1998 through 2012 in Taiwan were enrolled in this study. Based on the International Classification of Disease, 9th Revision, Clinical Modifi cation (ICD-9-CM) codes, basic information regarding medical comorbidities was extracted from the National Health Insurance Research Database (NHIRD). RESULTS: All patients were followed to the endpoint of the study or until death. The study enrolled 2,597 adult (≥ 18 years old) and 341 pediatric (< 18 years old) liver transplant recipients. The median age for the pediatric cohort was 1.88 years (interquartile range = 0.92-5.42 years). Four hundred and twenty-eight deaths occurred after LT in the total population, including 41 children. The median follow-up period was 6.1 years (interquartile range = 2.5-9.7 years) in pediatric liver transplant recipients. Pediatric patients with heart disease exhibited the highest risk of mortality. Further, during the entire study period of 14.5 years, patient survival rates were signifi cantly different (log-rank p = 0.002) for patients younger than 18 years and those older than 18 years. CONCLUSION: Cardiac disease is an important risk of mortality in pediatric LT. These fi ndings confi rm that the survival rate of LT is higher in pediatric patients than in adult patients.