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Improved results of living-related liver transplantation with routine application in a pediatric program
J C Emond1, T G Heffron, E O Kortz
1Department of Surgery, University of Chicago, Illinois.
Insights
Living related liver transplantation (LRT) significantly increases donor organ availability for pediatric patients, improving survival rates. This approach allows more children to receive transplants at the optimal time, expanding treatment options.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Gastroenterology
Background:
- Donor organ shortage is a critical issue in pediatric liver transplantation.
- Living related liver transplantation (LRT) was developed to address this shortage.
- Initial LRT outcomes showed promising patient and graft survival rates.
Purpose of the Study:
- To present the experience with 45 consecutive liver transplants, evaluating the role and outcomes of LRT.
- To assess the impact of LRT on graft availability and patient survival in a pediatric center.
- To determine the feasibility of expanding LRT for conditions like fulminant hepatic failure.
Main Methods:
- Retrospective analysis of 45 liver transplants performed between April 1991 and April 1992 in 41 children.
- Categorization of transplants into cadaveric donor and living related donor grafts.
- Analysis of patient demographics, underlying liver diseases, UNOS status, and outcomes (survival, graft loss).
Main Results:
- Overall patient survival was 90% across 45 transplants.
- Living related liver transplantation (LRT) accounted for 40% of grafts, with a patient survival of 94%.
- Cadaveric grafts had 88% patient survival and 74% graft survival, with many recipients on urgent UNOS status.
Conclusions:
- Living related liver transplantation (LRT) enhances graft availability, enabling timely transplants for pediatric patients.
- The benefits of increased graft availability with LRT outweigh concerns, supporting its routine use.
- LRT is a viable option for fulminant hepatic failure and may be extended to adult recipients.
Abstract:
Living related liver transplantation (LRT) was introduced as a response to the shortage of donor organs that has existed for small children. Results were promising in the initial experience, with a one-year patient survival of 80% and a graft survival of 75%. Since the completion of the protocol, LRT has been considered routinely in the management of children in our center. We present here our experience with 45 consecutive transplants in which LRT accounts for 40% of grafts with an overall patient survival of 90%. Between 4/91 and 4/92, 45 OLT were performed in 41 children. Median age was 2.7 years (3 months to 13 years) and weight was 10.4 kg (3.5-60 kg). Thirty-five were primary grafts, 10 were retransplants. One patient received 2 grafts in the orthotopic auxiliary position. Cholestatic disorders including biliary atresia accounted for 60%, metabolic diseases for 15%. Grafts were obtained from cadaver donors in 27/45 (60%) cases; reduction was required in 12/27 (44%). LRT was performed in 18 cases. Fifty-two percent of recipients of cadaver grafts were UNOS status 4, while 16% of LRT recipients met these criteria. Actual patient survival for cadaver grafts is 21/24 (88%) and graft survival is 20/27 (74%). Patient survival in 18 LRT was 94%. Two grafts were lost to arterial thrombosis for a graft survival of 83%. All donors have been discharged and are well. One patient, a teenager with fulminant hepatitis, was successfully transplanted with a left lobe from his father. This experience demonstrates the programmatic flexibility accorded by use of LRT. Since 40% of grafts were LRT, more livers were available for urgent use for patients who did not have a donor available, as reflected in the 73% incidence of cadaver recipients on status 3 or 4. Therefore, patients are more likely to receive a transplant at the optimal time. We are now prepared to offer LRT for fulminant hepatic failure since the benefit of graft availability appears to outweigh concerns about coerced donation. The successful treatment of a teenaged patient may herald extension of LRT to adults. We conclude that the use of LRT should be expanded.