Utility of neonatal donors in pediatric liver transplantation: A single‐center experience

Abstract

Background The lack of age‐ and size‐matched organs result in higher waiting list mortality in pediatric recipients than adults. Organs from deceased newborns and infants are a valuable source to increase donor pool in pediatric liver transplantation. However, the feasibility and safety of using neonatal donors have not been well evaluated. Methods From 2014 to 2016, 48 deceased donor pediatric liver transplantations with donor age younger than 1 year old in our center were enrolled in this study. The recipients were divided into three groups based on the donor age (<1 month, 1 month ≤ to <3 months, and 3 months ≤ to <1 year). Recipient's characteristics, perioperative data, and postoperative complications were compared. Results Two‐year patient survival rates were 87.5%, 94.4%, and 95.5%, and 2‐year graft survival rates were 75%, 94.4%, and 95.5%, respectively, without significant difference. The liver grafts from donors younger than 3 months were more advantageous in terms of acute rejection and virus infection, while the young grafts were related to slight higher incidence of hepatic artery thrombosis and SFSS. Those complications could be effectively prevented or treated by our perioperative care strategies. In addition, eight recipients who received neonatal livers achieved comparable outcomes with recipients with older livers. Conclusion Our data revealed that the application of liver grafts from donors younger than 1 year old could achieve excellent outcome. In particular, neonatal donors could be safely used in well‐selected patients.

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

“…One of the most important indicators for donor‐to‐recipient matching was graft‐to‐recipient weight ratio (GRWR). The ideal GRWR was 2% to 4%, and the minimal accepted ratio was 1.5% . In some patients, a GRWR >4% was also acceptable if the abdomen could be closed without tension and postoperative ultrasound showed normal blood flow.…”

“…The ideal GRWR was 2% to 4%, and the minimal accepted ratio was 1.5%. 10,11 In some patients, a GRWR >4% was also acceptable if the abdomen could be closed without tension and postoperative ultrasound showed…”

Neonatal donation: are newborns too young to be recognized?

“…En-bloc renal transplantation from young donors is acceptable and safe, with a low complication rate, also in pediatric recipients [22]. Similarly, several studies have suggested that the utility of livers from donors with low body weight could be a potential strategy for increasing the availability of donors for well-selected pediatric recipients [23,24]. Moreover, kidney and liver transplantation show good results even with size and/or weight mismatched organs [22][23][24].…”

“…Similarly, several studies have suggested that the utility of livers from donors with low body weight could be a potential strategy for increasing the availability of donors for well-selected pediatric recipients [23,24]. Moreover, kidney and liver transplantation show good results even with size and/or weight mismatched organs [22][23][24]. Organ size matching is more delicate for heart and lung transplantation [18,21].…”

The diagnosis and management of intestinal obstruction after pediatric liver transplantation

“…Blood test and Doppler ultrasound were performed daily in the first week after surgery to monitor the recovery of graft and the condition of vessels 5 . Dual immunosuppressive therapy combining tacrolimus and steroids was applied as standard immunosuppressive strategy 6 …”