Related Experiment Video
Updated: Aug 26, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Influence of graft type on outcomes after pediatric liver transplantation
John P Roberts1, Tempie E Hulbert-Shearon, Robert M Merion
1Department of Surgery, University of California-San Francisco, San Francisco, CA, USA. robertsj@surgery.ucsf.edu
Insights
Living donor liver transplants offer better graft survival for children under 2 years old. However, older children and young adults may face higher risks with living donor grafts compared to deceased donor options.
Area of Science:
- Hepatology
- Transplantation immunology
- Pediatric surgery
Background:
- Liver transplantation is a critical treatment for pediatric and young adult liver failure.
- Graft selection significantly impacts patient outcomes in liver transplantation.
- Understanding donor graft type efficacy across different age groups is essential.
Purpose of the Study:
- To compare the outcomes of different donor graft types in liver transplantation for recipients under 30 years old.
- To identify the optimal donor graft strategy for pediatric and young adult liver transplant recipients.
- To analyze graft survival and mortality risks associated with deceased donor (full size and split) versus living donor grafts.
Main Methods:
- Analysis of 6467 first liver transplants from the US Scientific Registry of Transplant Recipients (1989-2000).
- Stratification of recipients by age: <2, 2-10, 11-16, and 17-29 years.
- Cox proportional hazards models used to assess adjusted patient and graft outcomes by donor graft type (deceased donor full size, deceased donor split, living donor).
Main Results:
- For recipients <2 years, living donor grafts showed significantly lower graft failure risk than deceased donor split and full-size grafts.
- Living donor grafts trended towards lower mortality risk than deceased donor split grafts in the <2 age group within the first year.
- Older children had higher graft loss risk with living donor transplants, while young adults showed poor outcomes with deceased donor split grafts.
Conclusions:
- Living donor liver transplantation is the preferred donor source for the most common pediatric age group (<2 years), offering superior graft survival.
- The optimal donor graft type varies by age, with living donor grafts being most beneficial for infants.
- Careful consideration of donor graft type is crucial for optimizing liver transplant outcomes in pediatric and young adult populations.
Abstract:
We sought to determine which type of donor graft provides children and young adults with the best outcomes following liver transplantation. Using the US Scientific Registry of Transplant Recipients database, we identified 6467 recipients of first liver transplants during 1989-2000 aged < 30 years. We used Cox models to examine adjusted patient and graft outcomes by age (< 2, 2-10, 11-16, 17-29) and donor graft type (deceased donor full size (DD-F), split (DD-S), living donor (LD)]. For patients aged < 2, LD grafts had a significantly lower risk of graft failure than DD-S (RR = 0.49, p < 0.0001) and DD-F (RR = 0.70, p = 0.02) and lower mortality risk than DD-S (RR = 0.71, p = 0.08) during the first year post-transplant. In contrast, older children exhibited a higher risk of graft loss and a trend toward higher mortality associated with LD transplants. In young adults, DD-S transplants were associated with poor outcomes. Three-year follow up yielded similar graft survival results but no significant differences in mortality risk by graft type within age group. For recipients aged < 2, LD transplants provide superior graft survival than DD-F or DD-S and trend toward better patient survival than DD-S. Living donor is the preferred donor source in the most common pediatric age group (< 2 years) undergoing liver transplantation.
