Outcomes of Liver Transplantation Using Pediatric Deceased Donor Livers

Abstract

Background:The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT.Methods:A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients.Results:There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients’ age ≤13 years) and 19 pediatric-to-adult LT (recipients’ age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P = 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752–0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P > 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (χ2=4.330, P = 0.037).Conclusions:Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.

Korea-nationwide incidence of pediatric deceased donors and single-institutional status of liver transplantation using pediatric donor liver grafts

“…The incidence of vascular complications reported in the pediatric LT literature is variable and can be up to 25%-33% [8][9][10]. Hepatic artery thrombosis is the most serious complication after LT and early hepatic artery thrombosis is the main cause of graft loss in pediatric LT. A similar incidence of early vascular complications was reported in the pediatric-to-pediatric LT group and in the pediatric-to-adult LT group [3]. Moreover, low body weight of the recipient was an independent risk factor for vascular complications in pediatric LT [3].…”

Adult liver transplantation using pediatric donor livers after cardiac or brain death: A report of three cases

“…Regarding the procurement of donor livers, it should be observed during organ harvesting that the blood vessels and biliary tract in the livers of the pediatric donors, particularly those of underweight children, are thin (9,(16)(17)(18). Therefore, a modified no.…”

“…Regarding the choice of recipients, patients with tumors as the primary disease and those with lower body weights are considered to be the optimal recipients in adult liver transplantation using pediatric donor livers (11,(16)(17)(18). Patients who have had >1 episode of gastrointestinal bleeding, multiple previous surgeries and/or severe portal hypertension are not considered ideal candidates for pediatric liver transplantations (11).…”

“…It is at times difficult to find matching child recipients for the organs of older-aged normally developed child donors (6). Therefore, liver transplantations in adults using pediatric donor livers have been performed to improve organ utilization (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). This has broadened the source of liver donors for transplantation in adults and certainly alleviated any shortages (7,8).…”

“…This has broadened the source of liver donors for transplantation in adults and certainly alleviated any shortages (7,8). Selection of optimal recipients and appropriate surgical methods based on the condition of the donor liver (including donor liver volume, caliber difference between donor and recipient vessels, and the spatial location of the donor liver in the abdominal cavity of recipients, are crucial for successful liver transplantation in adults using pediatric donor livers (16)(17)(18). At present, pediatric donation in China is still in its infancy (9)(10)(11)(12)(13)(14)(15).…”