Living Donor Liver Transplantation vs Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS/OPTN Database

Abstract

Introduction: Split and LDLT in pediatric patients has the potential to decrease wait-times and waitlist mortality. We aim to compare outcomes of pediatric patients undergoing LDLT and split liver transplantation (SLT) using left lateral segment (LLS) grafts. Methods: Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. Baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Results: Between 2010-2019, 911 pediatric LT were included in the analysis (LD graft group, n=508, split graft group, n=403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22-138) days vs. 46 (16-108) days; p=0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p=0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-,3-and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10kg or ≤10years old receiving a LD graft showed improved graft survival. Conclusion: LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.