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Updated: Jun 22, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Selection of live-related liver transplantation candidates
Beth A Rymeski1, Louise Flynn, Stephen P Dunn
1Department of General Surgery, Alfred I duPont Hospital for Children, Wilmington, DE 19803, USA. brymeski@christianacare.org
Insights
Living donor liver transplantation (LR) in children offers comparable survival to cadaveric (CAD) grafts. LR is best for younger children with lower scores on the pediatric end-stage liver disease (PELD) scale, showing fewer early complications.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Organ Transplantation
Background:
- Living donor liver transplantation (LR) is a crucial alternative for pediatric patients with end-stage liver disease.
- Comparing LR with cadaveric (CAD) donation outcomes is essential for optimizing donor selection and patient management.
Purpose of the Study:
- To compare outcomes between pediatric liver transplant recipients using living donor (LR) versus cadaveric (CAD) grafts.
- To evaluate the impact of the pediatric end-stage liver disease (PELD) score on perioperative morbidity and mortality in LR versus CAD recipients.
- To identify appropriate candidates for LR in pediatric liver transplantation.
Main Methods:
- Retrospective analysis of a transplant database and electronic medical records.
- Inclusion of demographic data and outcome measures for pediatric liver transplant recipients from 2000 to 2008.
- Comparison of graft and overall survival, patient age, PELD score, indications for transplantation, and perioperative complications between LR and CAD groups.
Main Results:
- No significant differences in graft or overall survival at 3 months or 1 year between LR and CAD groups (n=81).
- LR recipients were significantly younger (4.46 vs 7.41 years; P = .03) and had lower PELD scores (12.7 vs 22; P = .001).
- LR recipients experienced fewer returns to the operating room within 30 days (13.9% vs 34.1%; P = .03) but had a higher rate of biliary stricture requiring reoperation (22.2% vs 2.3%; P = .005).
Conclusions:
- Living donor liver transplantation is highly effective for selected pediatric patients, particularly those with parental donors and lower PELD scores.
- A lower PELD score at the time of transplantation may be associated with a reduced incidence of postoperative complications requiring reoperation in LR recipients.
- LR offers a viable alternative for pediatric liver transplantation, with careful patient selection being key to successful outcomes.
Purpose:
Living donor liver transplantation (LR) is an important alternative for children. We compared our outcomes of LR and cadaveric (CAD) graft recipients, with attention to the pediatric end-stage liver disease (PELD) score and perioperative morbidity and mortality to identify appropriate candidates for LR.
Methods:
Our transplant database and electronic medical records were searched for demographics and outcome measures.
Results:
From 2000 to 2008, 81 children underwent liver transplantation from 37 LR and 44 CAD donors. There were no significant differences in graft or overall survival at 3 months or 1 year. The LR group was significantly younger (4.46 +/- 5.2 years vs 7.41 +/- 6.6 years; P = .03) and had a significantly lower PELD score (12.7 +/- 13 vs 22 +/- 12; P = .001) at the time of transplantation. Ten patients were transplanted for unresectable tumor in the LR group vs 4 CAD (P = .03). Significantly fewer LR recipients required return to the operating room in the first 30 days posttransplant (13.9% vs 34.1%; P = .03). The LR recipients had a higher rate of biliary stricture requiring reoperation (22.2% vs 2.3%; P = .005).
Conclusions:
The LR liver transplantation is highly selected for patients with a parent donor who will need transplant but do not yet have a high PELD score. A lower PELD score at operation may have contributed to the lower incidence of postoperative complications requiring reoperation.
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