P.364: Increased psychosocial risk factors in pediatric liver transplant patients transplanted for fulminant liver failure.

Abstract

Introduction: Acute (ALF) and chronic liver failure (CLF) in pediatric patients are two distinct conditions both in terms of etiology and outcomes in pediatric liver transplant recipients. In South Africa (S.A), Hepatitis A and other viral infections account for 60% of causes of ALF and biliary atresia (BA) for about 50% of CLF paediatric liver transplant (PLT) recipients. Psychosocial determinants greatly impact the outcomes of pediatric patients post liver transplant and can affect survival and quality of life. The aim of this study was to do a comparative analysis of outcomes (patient and graft survival) between ALF and CLF PLT recipients and to assess associated factors impacting outcomes. Methods: Retrospective record review of all pediatric patients transplanted between 1 January 2013 till 31 December 2023 attending liver transplant clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a tertiary academic public/government sector hospital located in Johannesburg, South Africa. Permission to conduct the study was obtained from University of Witwatersrand HREC. Results: Records of 104 PLT recipients were analyzed with median age at transplant of 34 months (19.5 – 84.15). There were 26/104 (25%) patients who were transplanted for ALF and 78/104 (75%) for CLF. Biliary atresia was the underlying cause for: 50/104 (48%) of children transplanted and hepatitis A virus accounted for acute liver failure in 10/104 (9.6%) of patients. There was no significant difference in outcomes between ALF and CLF patients. There was a significant difference in psychosocial risk factors between both groups {14/26 (54%) vs14/78(17.9%) P =0.001} with ALF patients having a significant increase in psychosocial risk factors which was also independently found to be a risk factor on multivariate analysis.Conclusion: Psychosocial risk factors are independently associated with ALF compared to CLF in PLT recipients in a transplant centre in S.A. Despite this having no impact on patient and graft survival, psychosocial pretransplant criteria require further evaluation to better assess the ALF group of patients.