Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Kehar, Mohit; Parekh, Rulan S.; Stunguris, Jennifer; De Angelis, Maria; Van Roestel, Krista; Ghanekar, Anand; Cattral, Mark; Fecteau, Annie; Ling, Simon; Kamath, Binita M.; Jones, Nicola; Avitzur, Yaron; Grant, David; Ng, Vicky Lee
• Is Part Of: Transplantation direct. Volume 5:Issue 3(2019)
• Publication Date: 2019-03
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation -- Periodicals; 362.19795
• DOI: 10.1097/TXD.0000000000000865
• Languages: English
• ISSNs: 2373-8731

Abstract

Abstract : Background: Living donor liver transplantation (LDLT) is increasingly used to bridge the gap between the current supply and demand imbalance for deceased donor organs to provide lifesaving liver transplantation. Methods: Outcomes of 135 children who underwent LDLT were compared with 158 recipients of deceased donor liver transplantation (DDLT) at the largest pediatric liver transplant program in Canada. Results: Recipients of LDLT were significantly younger than deceased donor recipients ( P ⩽ 0.001), less likely to require dialysis pretransplant ( P < 0.002) and had shorter wait time duration when the primary indication was cholestatic liver disease ( P = 0.003). The LDLT donors were either related genetically or emotionally (79%), or unrelated (21%) to the pediatric recipients. One-, 5-, and 10-year patient survival rates were significantly higher in LDLT (97%, 94%, and 94%) compared with DDLT (92%, 87%, and 80%; log-rank P = 0.02) recipients, as were graft survival rates (96%, 93%, and 93% for LDLT versus 89%, 81.4%, and 70%, respectively, for DDLT; log-rank P = 0.001). Medical and surgical complications were not statistically different between groups. Graft failure was higher in recipients of DDLT (odds ratio, 2.60; 95% confidence interval, 1.02, 6.58) than in the LDLT group after adjustment for clinical characteristics and propensity score. Conclusions: Living donor liver transplantation provides superior outcomes for children and is an excellent and effective strategy to increase the chances of receiving a liver transplant. Abstract : Supplemental digital content is available in the text.