Abstract
Waiting list mortality together, with limited availability of organs, are one of the major challenges in liver transplantation (LT). Especially in the paediatric population, another limiting factor is the scarcity of transplantable liver grafts due to additional concerns regarding graft size matching. In adults, donation after circulatory death (DCD) liver grafts have been used to expand the donor pool with satisfactory results. Although several studies suggest that DCD livers could also be used in paediatric recipients with good outcomes, their utilisation in children is still limited to a small number of reports. Novel organ perfusion strategies could be used to improve organ quality and help to increase the number of DCD grafts utilised for children. With the current manuscript, we present the available literature of LT using DCD grafts in paediatric recipients, discussing current challenges with the use of these livers in children and how machine perfusion technologies could be of impact in the future.
Highlights
Liver transplantation (LT) is the only effective treatment for end-stage liver disease or fulminant liver failure
The data shown in the literature and summarised in this review underline that with meticulous donor selection, adequate outcomes can be achieved with donation after circulatory death (DCD) grafts in paediatric recipients
The ideal DCD donor is considered as young and healthy, with short donor warm ischemia time (dWIT) (
Summary
Liver transplantation (LT) is the only effective treatment for end-stage liver disease or fulminant liver failure. Organ shortage is still one of the main challenges for the transplant community worldwide, especially in the paediatric population, where the disparity between the number of donors and recipients appears even higher compared to adults. Paediatric recipients, and in particular small children, face a unique challenge in receiving organs due to the graft size mismatch [1]. In this context, it has been shown that up to 30% of organs were declined based on size mismatch [1]. Despite the frequent utilisation of DCD livers in adult recipients, their use in the paediatric population remains limited. 2000s [7], the experience with DCD grafts in paediatric recipients is controversial and the literature is limited to a few case reports and small series [8–19]. We provide an overview of the currently available literature in paediatric DCD liver transplantation and discuss future directions
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