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Optimizing pediatric liver transplantation allocation: a simulation study on new splittable deceased donor criteria
Yuyoung Oh1, Nam-Joon Yi1, Kyung Chul Yoon1
1Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Split liver transplantation (SLT) could significantly reduce pediatric living donor liver transplantation (LDLT) and prevent deaths on the deceased donor liver transplantation (DDLT) waiting list in Korea. Expanding SLT policy is recommended.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Gastroenterology
Background:
- Organ distribution challenges in pediatric deceased donor liver transplantation (DDLT) in Korea.
- The potential of split liver transplantation (SLT) to address organ shortages.
- The current reliance on living donor liver transplantation (LDLT) for pediatric recipients.
Purpose of the Study:
- To analyze organ distribution in pediatric DDLT in Korea.
- To estimate the impact of adopting new criteria for splittable deceased donors.
- To advocate for the universal adoption of SLT.
Main Methods:
- Analysis of the Korean Network for Organ Sharing database (2000-2020).
- Identification of potential splittable donors based on weight ratio and existing SLT criteria.
- Estimation of avoided LDLT and preventable deaths by applying SLT principles.
Main Results:
- Identified 640 potential splittable donors over 20 years.
- Potential to nearly halve the 1,210 pediatric LDLT cases through SLT.
- Estimated 127 waiting list deaths could have been prevented with SLT.
Conclusions:
- SLT can decrease avoidable deaths in pediatric liver transplantation.
- SLT reduces the burden associated with LDLT.
- SLT does not compromise survival outcomes for adult DDLT recipients.
Background:
We analyzed the status of organ distribution in pediatric deceased donor liver transplantation (DDLT) in Korea. Additionally, we estimated how many pediatric patients could have avoided living donor liver transplantation (LDLT) or survived if new criteria for splittable deceased donors were adopted. Based on the findings, we advocate expanding policy to promote the universal adoption of split liver transplantation (SLT).
Methods:
Using the Korean Network for Organ Sharing database, we identified patients who underwent DDLT between January 2000 and December 2020. We considered "potential splittable donors" those with a donor-to-recipient weight ratio of ≥1.0 who met the existing SLT criteria (age 10-40 years; weight ≥50 kg). By comparing the numbers of pediatric LDLT recipients and potential splittable donors annually, we estimated how many patients might have avoided LDLT if the left lateral section of each splittable liver had been allocated to a child. Additionally, we compared the number of deaths on the DDLT waiting list with the number of potential splittable donors to estimate possibly preventable deaths.
Results:
Overall, we identified 640 potential splittable donors. Over the 20-year period, 1,210 pediatric patients (<19 years old) received LDLT. If potentially splittable livers had been split, this number could have been nearly halved. Furthermore, 127 patients died while on the DDLT waiting list. Using SLT with potential splittable donors, these deaths might have been prevented.
Conclusions:
SLT could reduce avoidable deaths among pediatric patients while decreasing the economic and social burden of LDLT, without compromising survival for adult DDLT recipients.
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