Survival among pediatric liver transplant recipients: Impact of segmental grafts

Abstract

Segmental liver transplantation with living donor (LD), reduced cadaveric (Reduced), and split cadaveric (Split) allografts has expanded the availability of size-appropriate organs for pediatric recipients. The relevance of recipient age to the selection of graft type has not been fully explored, but could offer the potential to maximize recipient outcome and donor utilization. We conducted a retrospective cohort study among children 12 years of age or less utilizing the United Network of Organ Sharing (UNOS) database. Cox proportional-hazards analysis was used to explore the association of recipient age and graft type to graft and patient survival. Among children <1 year of age and those 1 to 2 years of age, 3-year LD graft survival was superior to whole cadaveric (CAD) organs, Split grafts, and Reduced grafts (for children <1 year of age: 79.4 vs. 61.5, 66.0, and 61.1%, respectively, P ‫؍‬ .0003; and for children 1-2 years of age: 79.2 vs 66.9, 57.1, and 63.9%, respectively, P ‫؍‬ .02). However, in children 3 to 12 years of age, after controlling for multiple donor and recipient factors, LD grafts failed to offer a survival advantage (hazard ratio ‫؍‬ .61; 95% confidence interval ‫؍‬ .37-1.02) compared to CAD organs. In an adjusted analysis examining patient survival, there appeared to be minimal association between recipient age and graft type. Much of the difference in graft survival could be attributed to events in the perioperative period. In conclusion, LD liver transplantation provides improved graft survival in children 2 years of age or less.

Outcomes of 385 Adult-to-Adult Living Donor Liver Transplant Recipients

“…Initial reports have not demonstrated a clear advantage of ALDLT over deceased donor transplantation in the adult population, in contrast to the excellent outcomes reported in pediatric LDLT. 11,12,18,19 This difference may be due to possible differences in the surgical procedure and the wider spectrum of donor and recipient candidates involved in ALDLT compared with pediatric recipients of living donors. ALDLT includes a more heterogeneous donor population, and adult recipients have a wide range of disease severity and higher incidence of medical comorbidities not seen in pediatric recipients.…”

“…Unlike living donor transplantation in the pediatric population or in kidney transplantation, 11,12 there has yet to emerge a clear advantage of ALDLT over transplantation of the liver from deceased donors, beyond the obvious expansion of the donor pool. The extension of living donation to adult recipients requires a major hepatic resection in a healthy person to obtain an adequate graft, engendering controversy regarding both donor risk and increased complexity of the recipient operation.…”

Doadores limítrofes no transplante de fígado

“…Os aspectos a serem considerados para esse grupo devem ser avaliados. Em relação aos diversos tipos de enxerto cadáver e doador vivo, os resultados de sobrevida têm sido semelhantes, à exceção da sobrevida melhor para receptor e enxerto com uso de doador vivo em receptores abaixo de dois anos 32 (B), com menores índices de retransplante 33 (B). Com o uso de fígado reduzido tem-se a menor sobrevida de enxerto e de receptor, sendo recomendado priorizar a indicação do uso de split-liver sobre o fígado reduzido 32 (B).…”

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“…1 A return to ordinary lifestyle activities with normalized hypermetabolic state (versus that seen with liver insufficiency) and normal diet can cause progressive weight gain in these patients. [2][3][4] Determination of the predisposing factors contributing to mortality in patients with progressive liver insufficiency remains a challenging issue. In addition, determining the optimal time for transplant and the effective factors on short-term and long-term survival are debatable topics in this field.…”

“…These components of metabolic syndrome can increase the risk of cardiovascular disease. [1][2][3][4] As shown in a cross-sectional survey on adult liver transplant, 53% of patients had hypertension, 51% had hyperlipidemia, 37% had hyperglycemia, and 32% of patients had increased waist circumference at least 6 months after operation, with metabolic syndrome observed in 44.5%. 1 Some predisposing factors of metabolic syndrome after liver transplant are immunosuppressive drugs, higher age at time of operation, being male, higher body mass index (BMI) before transplant, pretransplant DM, underlying liver disease, and higher BMI in donors.…”