Effects of recipient size and allograft type on pediatric liver transplantation for biliary atresia

Area of Science:

• Hepatology
• Transplantation Surgery
• Pediatric Gastroenterology

Background:

• Pediatric liver transplantation is crucial for end-stage liver disease.
• Whole liver (WL) allografts are common, but partial liver allografts may benefit smaller recipients.
• Biliary atresia (BA) is a leading indication for pediatric liver transplantation.

Purpose of the Study:

• To compare national outcomes of liver transplantation in pediatric BA patients.
• To analyze the impact of allograft type (whole liver, deceased donor partial liver, living donor) on outcomes.
• To investigate the interaction between allograft type and recipient size.

Main Methods:

• Retrospective analysis of 2123 pediatric primary liver transplants for BA.
• Data collected from January 2, 2002, to December 30, 2014.
• Comparison of graft survival, vascular thrombosis, and retransplantation rates based on allograft type and recipient weight (≤7 kg and >14 kg).

Main Results:

• In recipients ≤7 kg, living donor liver transplantation (LDLT) and deceased donor partial liver (DDPL) allografts showed superior 1-, 5-, and 10-year graft survival compared to WL allografts (P=0.005).
• Vascular thrombosis and liver retransplantation rates were significantly higher with WL allografts in recipients ≤7 kg (P=0.002 and P=0.02, respectively).
• In recipients >14 kg, WL allografts trended towards better outcomes than DDPL allografts, though not statistically significant (P=0.06).

Conclusions:

• Technical variant allografts, including DDPL and LDLT, should be strongly considered for small pediatric recipients with BA.
• Allograft selection should be tailored to recipient size to optimize outcomes.
• Partial liver allografts demonstrate improved safety and efficacy in smaller pediatric liver transplant recipients with BA.