Liver transplantation in children weighing 5 kg or less: Analysis of the UNOS database

LT is a major medical and surgical challenge in very small patients. Aim of the study is to determine the outcomes after LT in infants <= 5 kg at transplant in a large cohort of patients. Methods: Infants <= 5 kg who had LT between 10/1987 and 5/2008 were identified from the UNOS database. Risk factors for death and graft loss were analyzed by multivariate logistic regression. Results: Of 11 467 children, 570 (5%) were <= 5 kg at LT. Mean age and weight at LT were 0.11 +/- 0.48 yr, 4.32 +/- 0.74 kg, respectively. One-and five-yr patient and graft survival were 77.7%, 72.2% and 66.1%, 57.6%, respectively. The primary cause of death was infection (25.9%). Recipient age was a predictor of graft loss. Patient and graft survival have improved over time. Life support at transplant was identified as a risk factor for both death and graft loss (p < 0.02, p < 0.01, respectively). Conclusion: LT recipients <= 5 kg have high mortality and graft loss. Over time, graft survival has improved, although it is still inferior to the overall reported outcomes of pediatric LT. Being on life support at transplant is a significant risk factor for death and graft loss in very small recipients.