Alternatives to whole liver transplants possible for children
Technical variant grafts may be better than whole grafts for living donor liver transplants in children.
(HealthDay News) — Alternatives to whole liver transplants for children have become safer, according to a study published recently in The Journal of Pediatrics.
Douglas B. Mogul, MD, MPH, from Johns Hopkins University in Baltimore, and colleagues evaluated patient and graft survival among 5715 pediatric liver-only transplant recipients who received an organ from March 1, 2002, to Dec. 31, 2015, to determine whether outcomes vary by graft type. The graft types were whole liver transplant, split liver transplant (SLT), and living donor liver transplant (LDLT).
The researchers found that 30-day survival for SLT improved (94 vs 98%; P < 0.001) from 2002-2009 to 2010-2015. At one year, survival for SLT and LDLT improved (89 to 95% [P < 0.001] and 93 to 98% [P = 0.002], respectively). However, at both 30 days and one year there was no change in survival for whole liver transplant (98% in both [P = 0.7] and 94 vs 95% [P = 0.2], respectively). With SLT, the risk of early death was 2.14-fold higher in 2002 to 2009, compared to whole liver transplant, but this risk disappeared in 2010 to 2015 (P = 0.04). In both time periods, the risk of late death after SLT was similar. On the other hand, LDLT had similar risk of early death and late death for both time periods. Graft loss was similar for SLT, but lower for LDLT.
"Greater use of technical variant grafts might provide an opportunity to increase organ supply without compromising post-transplant outcomes," the authors write.
- Mogul DB, Luo X, Bowring MG, et al. Fifteen-year trends in pediatrics liver transplants: Split, whole deceased, and living donor grafts. J Pediatr. 2018 Jan 4. doi: 10.1016/j.peds.2017.11.015.