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Deceased-donor partial liver transplants viable for young children

Outcomes of partial liver transplantation from deceased donors for very young recipients are comparable to those from whole liver transplantation, according to recent results.

Researchers assessed graft failure and mortality among 2,679 deceased-donor (DD) liver transplant recipients aged younger than 2 years, including 1,114 partial liver and 1,565 whole organ recipients. All participants were collected from the United Network for Organ Sharing database and underwent transplantation between 1995 and 2010.

Between 1995 and 2010, crude graft survival was significantly poorer with partial grafts (P<.001), but survival was similar between graft types from 2001 to 2005 (P=.43) and 2006 to 2010 (P=.36). Graft survival was worse overall with donors aged older than 40 years (P<.001), patients who required a ventilator (P<.001) and recipients who weighed fewer than 6 kg (P=.01).

Multivariable analysis indicated increased risk for failure and mortality with partial grafts conducted between 1995 and 2010 (adjusted HR=1.4; 95% CI, 1.05-1.89 for failure and aHR=1.41; 95% CI, 0.95-2.09 for mortality), but not between 2006 and 2010 (aHR=0.81; 95% CI, 0.56-1.18, failure; aHR=1.02; 95% CI, 0.66-1.71, mortality). For the entire cohort, partial transplantation was associated with a nonsignificant increased failure risk (aHR=1.14; 95% CI, 0.89-1.44), and a trend toward increased mortality risk (aHR=1.35; P=.08).

Factors predictive of mortality and graft failure included advanced donor age (P=.007, failure; P=.01, mortality), donor weight of 10 kg or lower (P<.001; P=.02), recipient weight of 6 kg or lower (P=.002; P<.001) and recipient ventilator use (P=.001; P<.001). Donor cold ischemia time of more than 9 hours (P=.03) and patient dialysis (P=.01) increased mortality risk.

“Our study confirms that there is no longer any increased risk of graft failure and mortality in the very young, regardless of whether or not the patient receives a partial or whole graft,” researcher Ryan Cauley, MD, MPH, said in a press release. “We are hopeful that this new data will support ongoing efforts to make modifications in the national liver allocation policy that makes more livers available for splitting, thereby saving lives and improving quality of life for many children and their families.”