A. Shubin1, C. S. Hwang1, P. Vagefi1, D. Desai1, M. MacConmara1 1University Of Texas Southwestern Medical Center,Department Of Surgery, Division Of Surgical Transplantation,Dallas, TX, USA
Introduction:
It is well recognized from clinical experiences in living liver transplantation that the use of small sized allografts can lead to early complications in the recipient, including primary graft non-function, however less is known about outcomes from whole organ use especially long term outcomes. We evaluated patient and allograft survival in adult liver recipients who received allografts from young pediatric donors to see if broader use of these organs is warranted.
Methods:
The United Network for Organ Sharing (UNOS) database was queried to examine the outcomes in all liver recipients from 1993 to 2017. Patients were then divided into those receiving their liver allograft from a small pediatric donor (<30Kg) or an adult graft. Further stratification was done on the basis of fulminant status of the recipient. Kaplan Meier survival curves were generated and categorical differences compared using the unpaired Student's t-test and nominal variables using either the Chi Square or Fischer's exact test. A p-value <0.05 was considered significant.
Results:
Data on 143,612 recipients was evaluated. 668 adult recipients received pediatric donor liver allografts and of those, 109 patients were transplanted for fulminant disease. The average pediatric donor age was 7.95 v 38.9 for adult donors while the donor to recipient weight difference was 35.2 v 4.5 Kg (p<0.05) respectively. The recipients of pediatric livers were smaller 61.2 v 82.7 Kg (p<0.05). Overall long term survival of recipients who received small pediatric allografts was not statistically different. In general recipients with fulminant disease had a worse outcome, however those adults with fulminant disease who received a small pediatric graft had markedly worse outcomes.
Conclusion:
Small pediatric liver grafts can be safely used in selective adult recipients and provide excellent outcomes.
