Donor size and early vascular complications in children receiving a whole liver transplant

Early vascular complications are one of the leading causes of morbidity and graft loss in paediatric whole liver transplant (WLT). It has been previously suggested that the donor size might influence these outcomes, but evidence remains insufficiently defined.

To evaluate the influence of donor weight on the incidence of early vascular complications after WLT in paediatric recipients.

Single-centre, retrospective cohort study on patients under 18 years old, who received a first WLT between 2000 and 2024. Recipients were classified according to the donor's weight: Subgroups A (≤ 15 kg) and B (> 15 kg). Demographic, anthropometric, surgical and perioperative variables were analysed, focusing on early vascular complications - hepatic artery thrombosis (HAT), portal vein thrombosis (PVT) - and the need for re-transplantation within 30 days postoperatively.

Sixty-four patients met the inclusion criteria. Subgroup A (n = 12) showed higher rates of early complications compared with subgroup B (n = 52): HAT 25% vs 5.8% [relative risks (RR): 4.3, 95%CI: 1.0-18.9, P = 0.074], PVT 16.7% vs 1.9% (RR: 8.7, 95%CI: 0.9-87.9, P = 0.088), and re-transplantation 16.7% vs 0% (RR: 5.4, 95%CI: 0.9-32.0, P = 0.033). Donor and recipient anthropometrics were highly correlated, precluding assessment of donor weight as an independent risk factor.

In paediatric WLT, grafts from small donors appear more susceptible to early vascular complications, reflecting the technical and anatomical vulnerability of small-calibre vessels rather than donor weight alone. Awareness of this relationship may assist in graft selection, intraoperative planning and postoperative surveillance.