[Efficacy and prognostic factors of split liver transplantation from pediatric donors]

Objective: To investigate the efficacy and prognostic factors of split liver transplantation (SLT) using pediatric donor livers. Methods: A retrospective analysis was conducted on the clinical data of pediatric donors and recipients who underwent SLT at the Third Affiliated Hospital of Sun Yat-sen University between January 2017 and July 2023. Donors were divided into younger children group (age≤7 years) and older children group (age>7 years) according to age. The clinical data of adult and pediatric recipients, and pediatric recipients receiving liver grafts from younger and older pediatric donors were compared and analyzed. The survival curves were drawn using the Kaplan-Meier method, and the prognosis of adult and pediatric recipients, and pediatric recipients receiving liver grafts from younger and older pediatric donors was compared using the log-rank test. Multivariate Cox proportional hazards regression model was used to analyze the risk factors affecting prognosis in recipients. Results: There were 30 pediatric donors, including 21 males and 9 females, aged (12.4±3.9) years and weighing (45.4±17.0) kg. There were 6 younger pediatric donors, aged (6.3±0.6) years and weighing [M (Q₁, Q₃)] 20.0(19.0, 21.0) kg. There were 24 older pediatric donors, aged (14.0±2.3) years and weighing 50.0(47.5, 60.0) kg. Grafts were allocated to 60 matched recipients based on graft-to-recipient weight ratio (GRWR), including 16 adult recipients [aged 50.0(44.0, 57.0) years and weighing 61.5(50.0, 65.0) kg] and 44 pediatric recipients [aged 1.0(0.3, 4.0) years and weighing 8.0(7.0, 15.0) kg], with 12 pediatric recipients receiving grafts from younger pediatric donors. The Model for End-Stage Liver Disease score for adult recipients was (24.4±11.7) points, with a GRWR of (1.6%±0.3%). Postopercitive complications occurred in 4 adult recipients, and 3 died. The Pediatric End-Stage Liver Disease score for pediatric recipients were (19.5±7.9) points, with a GRWR of (3.2%±1.0%). Among pediatric recipients, 12 experienced complications, and 6 died. Among the 12 recipients who received liver grafts from younger donors, 1 experienced a complication, and 2 died. There was no significant difference in the survival rate between pediatric and adult recipients at 1 year after surgery (95.5% vs 81.3%, P=0.100) and at 2 years after surgery (84.1% vs 81.3%, P=0.796). There was no significant difference in the survival rate between pediatric recipients receiving liver grafts from younger and older pediatric donors at 1 year after surgery (100.0% vs 93.8%, P=0.253) and at 2 years after surgery (91.7% vs 81.3%, P=0.374). Multivariate Cox proportional hazards regression analysis showed that long cold ischemia time (HR=0.990, 95%CI: 0.979-1.000), greater intraoperative blood loss (HR=1.000, 95%CI: 1.000-1.001), and postoperative infection (HR=15.736, 95%CI: 2.486-99.593) were risk factors for SLT recipient postoperative survival. Conclusions: SLT using pediatric donor livers is safe and feasible with favorable outcomes, however, grafts from younger donors warrant cautious evaluation. Cold ischemia time, intraoperative blood loss, and postoperative infection are prognostic factors.