194: Is there a preferred allograft type for pediatric liver transplant recipients?

Abstract

Background: Liver transplantation is the only curative option for pediatric patients with end-stage liver disease. In response to the shortage of pediatric whole-organ liver allografts, two strategies have been developed to increase the donor liver pool: cadaveric segmental liver allografts (which include both reduced partial-liver allografts and split-liver allografts), and living donor liver allografts. Previous studies have suggested that living donor liver transplantation (LDLT) results in superior patient survival for recipients less than 2 years of age when compared with cadaveric segmental liver transplantation (CSLT) and whole-organ liver transplantation (WLT). However, these studies used data obtained prior to 2001. Analysis of outcomes in patients transplanted after 2001 is warranted as the field of liver transplantation has incorporated improved surgical techniques and practices which are associated with better outcomes. Objective: To determine which allograft type is associated with superior patient and allograft survival rates in pediatric recipients transplanted in the current era. Methods: Data on all patients less than 12 years of age who underwent liver transplantation in the United States between 2/2002 and 12/2004 was obtained from the United Network of Organ Sharing (UNOS) database. After adjusting for multiple donor and recipient characteristics, the impact of allograft type on 1-year post-transplant patient and allograft survival was assessed with a multivariate Cox proportional hazards model. A single subgroup analysis was performed for recipients less than 2 years of age. Results: Of the 1,260 patients included in the study, 659 (52.3%) patients underwent WLT, 412 (32.6%) CSLT, and 189 (15%) LDLT. After risk-adjustment there was no significant difference in 1-year patient survival rates for WLT (94.2%), LDLT (92.8%), or CSLT (90.7%) recipients (p-values for the pairwise comparisons: 0.53 for WLT vs. LDLT, 0.41 for LDLT vs. CSLT, and 0.07 for WLT vs. CSLT). There was also no difference in 1-year allograft survival rates for WLT (84%), LDLT (86.4%), or CSLT (80.1%) recipients (p-values for the pairwise comparisons: 0.44 for WLT vs. LDLT, 0.07 for LDLT vs. CSLT, and 0.16 for WLT vs. CSLT). Likewise, for patients less than 2 years of age (n=755), the adjusted 1-year patient survival rates: WLT (95.5%), LDLT (92.1%), and CSLT (91.3%)did not differ significantly (p-values for the pairwise comparisons: 0.19 for WLT vs. LDLT, 0.79 for LDLT vs. CSLT. and 0.06 for WLT vs. CSLT). In this subgroup, allograft survival rates: WLT (83.2%), LDLT (86.3%), CSLT (80%) also did not differ significantly (p-values for the pairwise comparisons: 0.41 for WLT vs. LDLT, 0.12 for LDLT vs. CSLT, and 0.35 for WLT vs. CSLT). Conclusion: Whole organ, cadaveric segmental, and living donor liver allografts achieve similar outcomes in pediatric patients, including those less than 2 years of age. In the current era of liver transplantation, this most recent study justifies the use of all available liver allograft types to minimize waitlist mortality for pediatric patients with end-stage liver disease.