Pediatric liver transplant after traumatic liver injury: An analysis of the multicenter Scientific Registry of Transplant Recipients data set.

BACKGROUND

Liver injury is common in children with blunt or penetrating injury. In rare cases with devastating biliary or vascular injury, or posttraumatic acute hepatic failure, liver transplantation may be warranted. Outcomes of liver transplant after traumatic hepatic injury in children are not known. We hypothesized that pediatric patients who underwent liver transplantation after traumatic liver injury would have a decreased graft survival and similar patient survival, compared with children who underwent liver transplantation for other nontrauma indications.

METHODS

We retrospectively reviewed all pediatric (age 0-18 years) liver transplants in the Scientific Registry of Transplant Recipients database. Children with a liver transplant after traumatic liver injury were compared with children requiring transplant for other, nontrauma, indications. Propensity score matching was performed in a 5:1 ratio (nontrauma to trauma groups), with sex, race, age at transplant, and cold ischemia time used for matching variables. Metrics of graft and long-term survival were evaluated between the matched groups.

RESULTS

In total, 18,296 records were analyzed, with 12 patients receiving a liver transplant after trauma. Trauma patients were older and more likely to require pretransplant life support, compared with nontrauma patients. There were no significant differences in graft or long-term survival between the trauma and nontrauma patients, in either the propensity matched or unmatched analyses.

CONCLUSION

Liver transplant may be deemed necessary in rare cases of devastating hepatic injury in children. These data show no association between patients' graft- or long-term survival, and indication for liver transplant, between children transplanted after trauma and those after other indications. These data support consideration of liver transplant in devastating pediatric liver injury.

LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.