Application of pediatric donors in split liver transplantation: Is there an age limit?

Abstract

The experience of using pediatric donors in split liver transplant is exceedingly rare. We aim to investigate the outcomes of recipients receiving split pediatric grafts. Sixteen pediatric recipients receiving split liver grafts from 8 pediatric donors < 7 years were enrolled. The donor and recipient characteristics, perioperative course, postoperative complications, and graft and recipient survival rates were evaluated. The mean follow‐up time was 8.0 ± 2.3 months. The graft and recipient survival rates were 100%. The liver function remained in the normal range at the end of the follow‐up time in all recipients. No life‐threatening complications were seen in these recipients, and the only surgery‐related complication was portal vein stenosis in 1 recipient. Cytomegalovirus infection was the most common complication (62.5%). The transaminase level was significant higher in extended right lobe recipients in the early postoperative days, but the difference vanished at the end of first week; postoperative complications and graft and recipient survival rates did not differ between left and right graft recipients. Notably, the youngest split donor graft (2.7 years old) was associated with ideal recipient outcomes. Split liver transplant using well‐selected pediatric donors is a promising strategy to expand pediatric donor source in well‐matched recipients.

Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

“…In a more recent study by Gao et al, the outcomes of 16 pediatric recipients of pediatric split liver grafts were analyzed. The split liver grafts came from 8 pediatric donors less than 7 years of age ( 19 ). At a 3-months follow-up, both graft and patient survival were 100%.…”

“…At a 3-months follow-up, both graft and patient survival were 100%. The only surgical complication was portal vein stenosis, reported in 1 patient ( 19 ). This study also defined criteria for optimal split liver grafts in pediatric donors which includes a graft to recipient weight ratio of 2–4% ( 19 ).…”

“…The only surgical complication was portal vein stenosis, reported in 1 patient ( 19 ). This study also defined criteria for optimal split liver grafts in pediatric donors which includes a graft to recipient weight ratio of 2–4% ( 19 ). Thus, although pediatric split liver donors are not commonly performed, there are institutions with experience in this technique and the selection of appropriately sized recipients for the LLS and extended right grafts.…”

New technique for abdominal wall procurement. Initial experience

“…Moreover, unlike the technique described and MVT, 16 as well as for pediatric liver grafts. 17 We do note that there is no information regarding the ideal age of donors. In fact, in our case series, one of the donors was 55 years old; outcomes for this donor graft were not different than those for the other younger grafts.…”

Prophylactic Strategy Against De Novo Hepatitis B Virus Infection for Pediatric Recipients Who Receive Hepatitis B Core Antibody–Positive Liver Grafts

“…Unlike LDLT recipients who were well evaluated and controlled before transplantation, the arrival of a split‐liver graft was unpredictable, and it added difficulties in applying a preoperative prophylactic method to these patients. ( 23 ) Therefore, a special caution should be given when allocating HBcAb‐positive split graft to pediatric patients, especially in those patients with preoperative HBsAb titer <1000 IU/L. It is worth noting that none of the recipients receiving pediatric HBcAb‐positive grafts were diagnosed with de novo HBV infection.…”