Do Cold Ischemia and Transfusion Affect Pediatric Transplant Outcomes?

Area of Science:

• Hepatology
• Transplantation Surgery
• Pediatric Medicine

Background:

• Pediatric liver transplantation is crucial for end-stage liver disease.
• Living donor liver transplantation (LDLT) and Donation After Brain Death (DBD) are primary methods.
• Comparing outcomes is essential for optimizing pediatric liver transplant strategies.

Purpose of the Study:

• To compare clinical characteristics, postoperative complications, and survival rates.
• To evaluate differences between pediatric LDLT and DBD liver transplantation.
• To identify factors influencing outcomes in pediatric liver transplant recipients.

Main Methods:

• Retrospective analysis of 52 pediatric liver transplants (May 2017-March 2024).
• Statistical comparison using Chi-square and t-tests for characteristics and complications.
• Kaplan-Meier curves and Log-Rank tests for survival analysis (p < 0.05 significance).

Main Results:

• LDLT recipients were younger and lighter than DBD recipients (p < 0.001).
• LDLT had shorter cold ischemia times (158.9 vs. 299.0 min; p < 0.001) but required more transfusions (3.1 vs. 2.5 units; p < 0.001).
• DBD group had higher rates of hepatic artery stenosis/thrombosis; LDLT group had chylous leakage. Survival rates were similar (p = 0.137).

Conclusions:

• Longer cold ischemia time in DBD is linked to hepatic artery complications.
• Increased transfusions in LDLT may correlate with chronic rejection and chylous leakage.
• Improving surgical techniques and reducing ischemia time can enhance pediatric liver transplant outcomes.