Living donor liver transplantation in children: a single North American center experience over two decades

Area of Science:

• Pediatric Hepatology
• Transplant Surgery
• Health Economics

Background:

• Limited data exists on hospital charges and long-term outcomes for pediatric living donor liver transplantation (LDLT) in North America, particularly comparing different indications.
• Biliary atresia (BA) is a common indication for pediatric LDLT, often performed in younger children compared to other diagnoses.

Purpose of the Study:

• To compare patient and graft survival rates and healthcare charges for pediatric LDLT in patients with biliary atresia versus other diagnoses.
• To analyze trends in patient survival and associated costs over time within a single institution's LDLT program.

Main Methods:

• A retrospective review was conducted on 53 LDLTs performed between 1992 and 2010 in 52 children.
• Data collected included patient and donor survival, hospital charges, and transplant indications (38 BA, 14 non-BA).
• Statistical analysis compared outcomes and costs between BA and non-BA groups and examined survival trends over chronological periods.

Main Results:

• One-, five-, and 10-year patient and graft survival rates were comparable to national data.
• Average one-year charges were higher for BA patients ($242,849) than non-BA patients ($183,614), though not statistically significant (p=0.074).
• Patient survival significantly improved over time, with five-year survival rates increasing from 82% (1992-1995) to 100% (2001-2003) without a corresponding increase in indexed charges. All donors survived, with low complication rates.

Conclusions:

• Pediatric LDLT achieves excellent patient and donor outcomes.
• Significant improvements in patient survival have been realized without substantial increases in indexed healthcare charges.
• Further investigation into cost-reduction strategies and graft outcome maximization is warranted.