Graft Characteristics to Optimize Outcomes in Pediatric Liver Transplantation

Various efforts have been made to optimize the outcomes of pediatric liver transplantation (LT), which has become an established treatment for end-stage liver disease in children. Living donor liver transplantation (LDLT) and split deceased donor liver transplantation (DDLT) could increase the donor pool for children to dramatically reduce pretransplant waitlist mortality.

Graft characteristics to optimize the outcomes in pediatric LT have been analyzed from various aspects, including graft size matching, donor/graft quality, and graft procurement procedure. This special article reviews the current literature and delineates the principles/measures to make an appropriate graft selection and the graft procurement to obtain good-quality grafts.

Several studies related to graft size matching in LDLT have elucidated the pathogenesis of "small-for-size" and "large-for-size" issues. The procedures used to make reduced left lateral segment grafts have been technically refined, and these grafts are widely applicable for small children. The livers from ABO-incompatible donors, hepatitis B core antibody-positive donors, and parental donors with a background of congenital inherited genetic disorders have been successfully transplanted into children by overcoming each barrier, and these livers are widely used in LDLT. Machine perfusion is a promising modality to optimize the extended criteria donor organs with outcomes comparable to those of good-quality grafts.

A multidisciplinary approach, leveraging each advantage between DDLT and LDLT, is going to achieve the best outcomes in the field of pediatric LT. In addition, minimally invasive donor hepatectomy must be promoted to guarantee donor safety without compromising graft quality.