New research reveals that transplantation of partial livers from
deceased adult and teen donors has become less risky for infants and
young children, helping to save these young lives. Findings published
online in Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
and the International Liver Transplantation Society, indicate that risk
of organ failure and mortality from partial or split liver transplant
was comparable to whole organ transplant in this pediatric population.
Available livers for transplantation are in short
supply, particularly size-matched organs for the youngest patient on the
waitlist. While there is evidence that partial organs donated from
living donors are superior to those from deceased donors, they accounted
for less than 11% of pediatric liver transplants in 2010. Since 2002,
studies show an eight-fold increase in the use of partial grafts from
deceased donors, accounting for up to 32% of liver transplants in
children.
“Infants and young children have the highest waitlist
mortality rates among all candidates for liver transplant,” explains
senior author Dr. Heung Bae Kim, Director of the Pediatric Transplant
Center at Boston Children’s Hospital in Massachusetts. “Extended time
on the liver transplant waitlist also places children at greater risk
for long-term health issues and growth delays, which is why it is so
important to look for methods that shorten the waitlist time to reduce
mortality and improve quality of life for pediatric patients.”
To further understand outcomes of using deceased
donor partial livers in infants, the team identified 2,679 liver
transplant recipients under the age of two in the United Network of
Organ Sharing (UNOS) database from 1995-2010. There were 1,114 partial
livers and 1,565 whole organs from deceased donors that were used in the
transplants analyzed. They examined mortality and graft survival over
time.
Graft survival between partial and whole grafts were
significantly different in 1995-2000, but comparable in 2001-2005 and
2006-2010, suggesting that transplants using partial livers became less
risky over time. Adjusted risk of graft failure and mortality was
similar for partial and whole organs in 2006-2010.
“Infants continue to have twice the mortality rate of
adult candidates on the waitlist,” concludes Dr. Kim. “Our study
confirms that organ failure and mortality risk in the very young was
similar for partial and whole organs from deceased donors. The
transplant community must continue to look for ways to reduce mortality
rates in pediatric patients and using partial livers from deceased, as
well as living donors, may hold the key.”
Full citation: “Deceased Donor Liver
Transplantation in Infants and Small Children: Are Partial Grafts
Riskier Than Whole Organs?” Ryan P. Cauley, Khashayar Vakili, Kristina
Potanos, Nora Fullington, Dionne A. Graham, Jonathan A. Finkelstein and
Heung Bae Kim. Liver Transplantation; (DOI: 10.1002/lt.23667) Online Publication: May 21, 2013.
URL: http://doi.wiley.com/10.1022/lt.23667
Author Contact: Media wishing to speak with Dr. Kim may contact Keri Stedman with Boston Children’s Hospital at +1 617-919-3114 or at keri.stedman@childrens.harvard.edu.
Labels: children, pediatric, transplant