Survival among pediatric liver transplant recipients: Impact of segmental grafts

Authors

  • Peter L. Abt,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
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  • Rachel Rapaport-Kelz,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
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  • Niraj M. Desai,

    1. Department of Surgery, Washington University School of Medicine, St. Louis, MO
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  • Adam Frank,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
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  • Seema Sonnad,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
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  • Elizabeth Rand,

    1. Department of Pediatrics, Division of Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, PA
    2. Fred and Suzanne Biesecker Center for Liver Disease, Children's Hospital of Philadelphia, Philadelphia, PA
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  • James F. Markmann,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
    2. Fred and Suzanne Biesecker Center for Liver Disease, Children's Hospital of Philadelphia, Philadelphia, PA
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  • Abraham Shaked,

    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
    2. Fred and Suzanne Biesecker Center for Liver Disease, Children's Hospital of Philadelphia, Philadelphia, PA
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  • Kim M. Olthoff

    Corresponding author
    1. Department of Surgery, University of Pennsylvania, Philadelphia, PA
    2. Fred and Suzanne Biesecker Center for Liver Disease, Children's Hospital of Philadelphia, Philadelphia, PA
    • Department of Surgery, Division of Transplantation, 4 Silverstein, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
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    • Telephone: 215-662-6136; FAX: 215-662-7476


Abstract

Segmental liver transplantation with living donor (LD), reduced cadaveric (Reduced), and split cadaveric (Split) allografts has expanded the availability of size-appropriate organs for pediatric recipients. The relevance of recipient age to the selection of graft type has not been fully explored, but could offer the potential to maximize recipient outcome and donor utilization. We conducted a retrospective cohort study among children 12 years of age or less utilizing the United Network of Organ Sharing (UNOS) database. Cox proportional-hazards analysis was used to explore the association of recipient age and graft type to graft and patient survival. Among children <1 year of age and those 1 to 2 years of age, 3-year LD graft survival was superior to whole cadaveric (CAD) organs, Split grafts, and Reduced grafts (for children <1 year of age: 79.4 vs. 61.5, 66.0, and 61.1%, respectively, P = .0003; and for children 1-2 years of age: 79.2 vs 66.9, 57.1, and 63.9%, respectively, P = .02). However, in children 3 to 12 years of age, after controlling for multiple donor and recipient factors, LD grafts failed to offer a survival advantage (hazard ratio = .61; 95% confidence interval = .37-1.02) compared to CAD organs. In an adjusted analysis examining patient survival, there appeared to be minimal association between recipient age and graft type. Much of the difference in graft survival could be attributed to events in the perioperative period. In conclusion, LD liver transplantation provides improved graft survival in children 2 years of age or less. (Liver Transpl 2004;10:1287–1293.)

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