Effect of small donor weight and donor–recipient weight ratio on the outcome of liver transplantation in children

Abstract

A small donor weight is a risk factor for HAT with potential for graft loss. To test this hypothesis, we evaluated outcomes of pediatric liver transplants utilizing donors <20 kg using the UNOS database from 01/2003 to 01/2012 (n = 1311). All isolated liver transplants with whole organ grafts were included. Recipients were divided into four groups based on donor weight: group 1, donor weight <5 kg (n = 34 [2%]); group 2, 5-10 kg (431 [33%]); group 3, 10-15 kg (560 [43%]); and group 4, 15-20 kg (286 [22%]). Actuarial patient survival for the first year post-transplant was significantly lower in groups 1 and 2 compared to groups 3 and 4 (p = 0.002), similarly the one-yr graft function (p < 0.0001). The difference was due to graft loss within the first month for groups 1 and 2. HAT was significantly higher in groups 1 and 2 compared to others (p = 0.0006). Logistic regression analysis demonstrated donor weight as the most predictive factor with analysis of the ROC curve showing a cutoff point at 7.8 kg. The donor-recipient weight ratio did, in none of the models, gain statistical significance.

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

“…Median age at transplant was 1.7 years old (IQR 0.67-6.7), and median weight was 10.6 kg (IQR 6. [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Overall, the most common diagnosis leading to liver transplant was biliary atresia (n = 47, 37%), followed by malignancy (n = 25, 20%).…”

“…5,8,[10][11][12] A number of studies have attempted to elucidate potential contributing factors such as preoperative hemoglobin, 6 cytomegalovirus (CMV), 3,7 intraoperative HAT, 9 or cold ischemia time, 9 and others have reported on potential preventative strategies such as multiple hepatic artery anastomoses. 9,12 Several studies have also focused on the association between donor weight 13,14 or graft weight 9,12 and HAT. Since there are no established uniform practice patterns for minimizing HAT in pediatric liver recipients, we sought to examine the HAT rate and associated recipient and donor factors at our institution in order to identify modifiable factors that might reduce its incidence.…”

International survey on anticoagulation and antiplatelet strategies after pediatric liver transplantation

“…Factors leading to thrombosis can be classified in surgical and non‐surgical. Surgical risk factors include small vessel size, small recipient, donor‐recipient vessel size disparity, low graft to recipient weight ratio and surgical technique (prolonged ischemia time, arterial grafts, multiple arterial revisions and bench reconstruction) . Non‐surgical risk factors include acute rejection, cytomegalovirus infection, intraoperative FFP use, elevated postoperative hematocrit, thrombophilia, and lack of postoperative anticoagulation .…”

Untitled

“…1 Advances in surgical techniques, immuno suppressive therapy, and postoperative intensive care are resulting in increased success rates in these patients. 2,3 However, there also are increased complications in pediatric liver transplant patients compared to adult liver transplant patients, particularly related to vascular thrombosis-associated graft loss.…”

“…2,3 However, there also are increased complications in pediatric liver transplant patients compared to adult liver transplant patients, particularly related to vascular thrombosis-associated graft loss. 1,2 There are 3 graft types used in pediatric patients: (1) whole organ deceased-donor transplant, (2) deceased-donor split liver transplant, and (3) livingdonor liver transplant. 2 A mismatch in graft size versus patient size is a rare but critical issue in livingdonor liver transplant.…”