Surgery · 2026
Liver transplantation for primary sclerosing cholangitis in children versus young adults.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ziogas Ioannis A, Maloney Lauren, Yoeli Dor, Baimas-George Maria, Tsoulfas Georgios, Conover Katie R, Rolfes Priya S, Feldman Amy G, Adams Megan A, Taylor Sarah A
Аннотация
INTRODUCTION: Primary sclerosing cholangitis is an immune-mediated cholestatic liver disease characterized by inflammation of the intra- and/or extrahepatic bile ducts and is associated with inflammatory bowel disease.
METHODS: We retrospectively compared children (<18 years) and young adults (18-25 years) undergoing first liver transplantation for primary sclerosing cholangitis using United Network for Organ Sharing data (February 2002-December 2024).
RESULTS: A total of 531 patients with primary sclerosing cholangitis underwent liver transplantation (160 children; 371 young adults). Children had lower laboratory Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score than young adults (median 13.0 vs 20.0, P < .001). A smaller proportion of children had inflammatory bowel disease (58.8% vs 67.9%, P = .04), ascites (35.9% vs 47.8%, P = .01), and underwent living donor liver transplantation (18.1% vs 29.9%, P < .001) than young adults. Multivariable Cox regression showed decreased risk of patient mortality in children versus young adults (hazard ratio 0.49, 95% confidence interval 0.27-0.89, P = .02) and White, non-Hispanic patients compared with other race/ethnicity (0.44, 0.27-0.73, P = .001), when adjusting for inflammatory bowel disease, Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score, intensive care unit status, graft type, and era. Multivariable Cox regression showed decreased risk of graft loss in female versus male sex (hazard ratio 0.68, 95% confidence interval 0.49-0.96, P = .03) and White, non-Hispanic patients compared with other race/ethnicity (0.71, 0.50-0.99, P = .04), when adjusting for inflammatory bowel disease, Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score, intensive care unit status, graft type, and era.
CONCLUSION: Pediatric liver transplantation recipients with primary sclerosing cholangitis exhibit superior patient survival versus young adult liver transplantation recipients, whereas graft survival does not differ significantly. White, non-Hispanic race/ethnicity was independently associated with improved survival, underscoring persistent disparities in liver transplantation outcomes.
METHODS: We retrospectively compared children (<18 years) and young adults (18-25 years) undergoing first liver transplantation for primary sclerosing cholangitis using United Network for Organ Sharing data (February 2002-December 2024).
RESULTS: A total of 531 patients with primary sclerosing cholangitis underwent liver transplantation (160 children; 371 young adults). Children had lower laboratory Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score than young adults (median 13.0 vs 20.0, P < .001). A smaller proportion of children had inflammatory bowel disease (58.8% vs 67.9%, P = .04), ascites (35.9% vs 47.8%, P = .01), and underwent living donor liver transplantation (18.1% vs 29.9%, P < .001) than young adults. Multivariable Cox regression showed decreased risk of patient mortality in children versus young adults (hazard ratio 0.49, 95% confidence interval 0.27-0.89, P = .02) and White, non-Hispanic patients compared with other race/ethnicity (0.44, 0.27-0.73, P = .001), when adjusting for inflammatory bowel disease, Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score, intensive care unit status, graft type, and era. Multivariable Cox regression showed decreased risk of graft loss in female versus male sex (hazard ratio 0.68, 95% confidence interval 0.49-0.96, P = .03) and White, non-Hispanic patients compared with other race/ethnicity (0.71, 0.50-0.99, P = .04), when adjusting for inflammatory bowel disease, Model for End-stage Liver Disease / Pediatric End-stage Liver Disease score, intensive care unit status, graft type, and era.
CONCLUSION: Pediatric liver transplantation recipients with primary sclerosing cholangitis exhibit superior patient survival versus young adult liver transplantation recipients, whereas graft survival does not differ significantly. White, non-Hispanic race/ethnicity was independently associated with improved survival, underscoring persistent disparities in liver transplantation outcomes.