Outcomes and Risk Factors of Pediatric Liver Transplantation in A Resource‐Limited Setting: A 15‐Year Cohort Study
Niken Wahyu Puspaningtyas, Jerrie Syauqi Hartinta, Ilona Nathania, Tartila Tartila, Tri Hening Rahayatri, Sastiono Sastiono, Hanifah Oswari, Antonius Hocky PudjiadiABSTRACT
Background
Liver transplantation is the definitive treatment for end‐stage liver disease in children. Despite improved survival, mortality and acute rejection remain significant. Evidence from developing countries is limited; therefore, this study aimed to evaluate one‐year mortality, acute rejection, and associated risk factors in pediatric liver transplant recipients at a national referral center in Indonesia.
Methods
A retrospective cohort study was conducted among pediatric liver transplant recipients aged < 18 years at Cipto Mangunkusumo Hospital (2010–2025). Survival was analyzed using the Kaplan–Meier method. Cox proportional hazards regression and logistic regression were applied to identify factors associated with one‐year mortality and acute rejection, respectively. Variables with p < 0.25 in univariate analysis and clinically relevant factors were included in multivariable models.
Results
A total of 87 patients were included. The one‐year mortality rate was 18.4% (overall survival 81.6%), with most deaths occurring within the first 5 months, particularly the first month. Operation duration > 12 h was independently associated with increased mortality (HR 4.13, 95% CI 1.16–14.64; p = 0.028). Acute rejection occurred in 27.6% of patients. No independent factor was significantly associated with acute rejection in multivariable analysis, although vascular complications showed a borderline association (OR 3.83, 95% CI 0.95–15.43; p = 0.059).
Conclusions
This study demonstrates favorable one‐year outcomes. Prolonged operative duration was independently associated with increased mortality, while no independent predictor was significantly associated with acute rejection. These findings highlight the importance of perioperative optimization and continued evaluation of factors influencing graft‐related outcomes.