Frequency of whole‐organ in lieu of split‐liver transplantation over the last decade: Children experienced increased wait time and death. Issue 11 (24th June 2019)

• Record Type: Journal Article
• Authors: Valentino, Pamela L.; Emre, Sukru; Geliang, Gan; Li, Luhang; Deng, Yanhong; Mulligan, David; Rodriguez‐Davalos, Manuel I
• Is Part Of: American journal of transplantation. Volume 19:Issue 11(2019)
• Page Start: 3114
• Page End: 3123
• Publication Date: 2019-06-24
• Subjects: clinical research/practice -- disparities -- donors and donation: deceased -- ethics and public policy -- liver transplantation/hepatology -- liver transplantation: split -- organ allocation -- organ procurement and allocation -- pediatrics -- United Network for Organ Sharing (UNOS); Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15481
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Organ shortage is a barrier to liver transplantation (LT). Split LT (SLT) increases organ utilization, saving 2 recipients. A simulation of Organ Procurement and Transplantation Network/United Network for Organ Sharing data (2007‐2017) was performed to identify whole‐organ LT grafts (WLT) that met the criteria for being splittable to 2 recipients. Waitlist consequences presented. Deceased donor (DD) livers transplanted as whole organs were evaluated for suitability to split. Of these DD organs, we identified the adolescent and adult recipients of WLT who were suitable for SLT. Pediatric candidates suitable to share the SLT were ascertained from DD match‐run lists, and 1342 splittable DD organs were identified; 438 WLT recipients met the criteria for accepting a SLT. Review of the 438 DD match‐run lists identified 420 children next on the list suitable for SLT. Three hundred thirty‐three children (79%) underwent LT, but had longer wait‐times compared to 591 actual pediatric SLT recipients (median 147 days vs 44 days, P < 0.001). Thirty‐three of 420 children died on waitlist after a mean 206 days (standard deviation 317). Sharing organs suitable for splitting increases the number of LT, saving more lives. With careful patient selection, SLT will not be a disadvantage to the adult recipients. With a children‐first allocation scheme, SLT will naturally increase the number of allografts because adult organs are too large for small children. Abstract : In a simulation of OPTN data supplied by UNOS to identify deceased donor organs over the past decade that could have been safely split between two candidates and instead were transplanted as whole organs, the authors identify 420 children who could have received a split liver transplant instead of dying on the waitlist or waiting an average 8.5 months until transplant.