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Pediatric liver grafts well-tolerated in adult LT recipients

Research published in Liver Transplantation suggests adults may benefit from liver grafts that cannot be used in pediatric patients.

“There was no difference in patient and graft survival between adult recipients transplanted with liver grafts from pediatric and adult donors,” Kristopher P. Croome, MD, and colleagues at the department of transplant at the Mayo Clinic in Jacksonville, Fla., wrote. “The short-term and long-term survival analyses presented herein support the use of these organs when they have been declined for all available pediatric recipients.”

The researchers looked at all liver transplant recipients from Feb. 27, 2002 to Nov. 30, 2014 who have since died. Pediatric donors were defined as those aged younger than 12 years; adult donors were aged older than 18 years. The researchers separated adults based on which age group the patient’s donor came from. Researchers used established formulas to determine standard total liver volume and body surface area. Graft life was determined based on how long a patient lived after transplant, the date a graft was lost or the date a patient last checked in for treatment.  

Croome and colleagues wrote patient survival at 1, 3 and 5 years was 88%, 83% and 77% in the pediatric-to-adult LT group and 88%, 79% and 73% in the adult-to-adult LT group. Graft survival over the same period was 84%, 78% and 72% in the pediatric-to-adult group and 84%, 75% and 69% in the adult-to-adult group.

“We demonstrated that acceptable patient and graft survival can be achieved with the use of pediatric liver grafts in adult recipients,” researchers wrote.

There are concerns over using smaller tissue grafts for LT, Mike Kueht, MD, of the division of abdominal transplantation hepatobiliary surgery, Baylor College of Medicine, Houston, and colleagues wrote in a related editorial.

“It has been previously recognized as portending inferior long-term survival, but maybe even more commonly, it is associated with more complications, a longer hospital stay and again may not be obvious in the [United Network for Organ Sharing] database,” they wrote. 

Croome and colleagues also studied why pediatric donor livers were declined in pediatric-to-adult, pediatric-to-pediatric and pediatric-donor-liver-not-used groups. Researchers found in these latter two groups, organs were refused for size/quality first, then size/weight. The order of these refusals was switched for pediatric-to-adult group.

“We also demonstrated larger donor liver size, higher donor AST/ALT, higher creatine and larger proportion of [donation after cardiac death] as differences between pediatric organs used for pediatric patients and pediatric organs used for adults.” – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.