Living Donor Liver Transplant Center Volume Influences Waiting List Survival Among Children Listed for Liver Transplantation

Abstract

Background. Pediatric living donor liver transplantation (LDLT) remains infrequently performed in the United States and localized to a few centers. This study aimed to compare pediatric waiting list and posttransplant outcomes by LDLT center volume. Methods. The Scientific Registry of Transplant Recipients/Organ Procurement and Transplantation Network database was retrospectively reviewed for all pediatric (age <18 y) liver transplant candidates listed between January 1, 2009, and December 31, 2019. The average annual number of LDLT, deceased donor partial liver transplant (DDPLT), and overall (ie, LDLT + DDPLT + whole liver transplants) pediatric liver transplants performed by each transplant center during the study period was calculated. Results. Of 88 transplant centers, only 44 (50%) performed at least 1 pediatric LDLT during the study period. LDLT, DDPLT, and overall transplant center volume were all positively correlated. LDLT center volume was protective against waiting list dropout after adjusting for confounding variables (adjusted hazard ratio, 0.92; 95% confidence interval, 0.86-0.97; P = 0.004), whereas DDPLT and overall center volume were not (P > 0.05); however, DDPLT center volume was significantly protective against both recipient death and graft loss, whereas overall volume was only protective against graft loss and LDLT volume was not protective for either. Conclusions. High-volume pediatric LDLT center can improve waiting list survival, whereas DDPLT and overall volume are associated with posttransplant survival. Expertise in all types of pediatric liver transplant options is important to optimize outcomes.

The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions

“…[6] As such, a higher volume of pediatric LDLT is associated with superior waiting list survival among centers in the US. [7] A similar trend has been demonstrated in Europe, where a recent increase in the volume of pediatric LDLT was associated with a subsequent improvement in waiting list mortality. [8] Although LDLT is one option to expand the donor pool for children, increasing evidence suggests that it may actually be the best option.…”

Insufficient use of technical variant grafts: An unfulfilled promise in pediatric liver transplantation

“…The authors demonstrate that center volume and living donor liver transplantation (LDLT) expertise protect against graft failure and death, confirming prior studies 4,6,7 . As data continue to underscore the importance of being able to offer a TVG to reduce WL mortality, a key question is this: how should equal access to these options be ensured?…”

Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting

“…LDLT is one way to expand the pool of size-matched grafts, reduce children’s wait time for transplant, and improve outcomes. 7,8 Pediatric LD recipients have better graft and patient survival than deceased donor recipients. 1 However, from 2018 to 2020, only 13% of US pediatric LTs were LDLTs; this percentage has remained stagnant over the past decade.…”

“…Between 2009 and 2019, only 50% (44 of 88) of pediatric LT centers performed an LDLT, and only 13 centers performed 5 or more LDLTs in any given year. 7 High LDLT center volume is not only protective against waitlist death; it also increases a child's chance at prompt LT-before they deteriorate and accumulate morbidity. 7,9 Even when a child has no identified LD, listing at an LDLT center may provide access to a nondirected LD.…”

“…Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting Amy G. Feldman, MD, MSCS, 1 Megan Adams, MD, 2 Adam D. Griesemer, MD, 3 Simon Horslen, MB, ChB, FRCPCH, 4 Beau Kelly, MD, MBA, FACS, FAST, 5 Alisha M. Mavis, MD, 6 George V. Mazariegos, MD, 7 Vicky L. Ng, MD, FRCPC, 8 Emily R. Perito, MD, MAS, 9 Manuel I. Rodriguez-Davalos, MD, FACS, 10 James E. Squires, MD, MS, 4 Greg Tiao, MD, 11 George S. Yanni, MD, FAASLD, 12 and Evelyn K. Hsu, MD 13 T he Society of Pediatric Liver Transplantation (SPLIT) has grown into a community of over 40 centers with synergistic platforms in research, education, advocacy, quality improvement, and clinical care. In 2019, SPLIT joined forces with the Transplantation Society in a mission to improve the lives of children who require (and undergo) liver transplantation (LT).…”