Livers From Pediatric Donation After Circulatory Death Donors Represent a Viable and Underutilized Source of Allograft

Abstract

Despite increased numbers of donation after circulatory death (DCD) donors, pediatric DCD livers are underused. To investigate possible reasons for this discrepancy, we conducted a retrospective cohort study using 2 data sets from the Organ Procurement and Transplantation Network for all deceased liver donors and for all recipients of DCD liver transplants from March 8, 1993, to June 30, 2018. Pediatric (0‐12 years) and adolescent (13‐17 years) DCD donors were compared with those aged 18‐40 years. We found that pediatric DCD allografts are recovered at a significantly lower rate than from 18‐to‐40‐year‐old donors (27.3% versus 56.3%; P < 0.001). However, once recovered, these organs are transplanted at a similar rate to those from the 18‐to‐40‐year‐old donor cohort (74.7% versus 74.2%). Significantly more pediatric DCD livers (odds ratio [OR], 3.75; confidence interval [CI], 3.14‐4.47) were not recovered compared with adult organs, which were most commonly not recovered due to organ quality (10.2% versus 7.1%; P < 0.001). The 10‐year relative risks (RRs) for graft failure and patient death were similar between pediatric and adult DCD donors, with adolescent DCD livers demonstrating improved outcomes. DCD livers transplanted into pediatric donors were protective against graft failure (RR, 0.46; 95% confidence interval [CI], 0.21‐0.99) and patient death (RR, 0.16; 95% CI, 0.04‐0.69). In conclusion, despite lower rates of recovery, pediatric DCD livers represent a viable organ source for certain adults and children.

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

“…In context of the potential donor and recipient age mismatch, there is a general reluctance to use DCD liver grafts for pediatric recipients. 90,91 Hwang et al 91 showed equal graft survival rates in pediatric DCD and DBD recipients in the UNOS cohort from very young donors with an age of 11 and 12 y, respectively. DCD liver grafts are also more frequently transplanted into older children.…”

Normothermic Regional Perfusion in Pediatric Controlled Donation After Circulatory Death Can Lead to Optimal Organ Utilization and Posttransplant Outcomes

“…24 Despite an increasing number of cDCD donors, an alarming rate of nonrecovery and discarded livers from pediatric cDCD donors have been published. 25 A recent United Network for Organ Sharing national registry study showed that cDCD accounted for <5% (443 from 8967) of livers transplanted from pediatric donors. 23 Most large series of pediatric cDCD donors have shown that livers are massively allocated into adult recipients.…”

“…23 Most large series of pediatric cDCD donors have shown that livers are massively allocated into adult recipients. 23,25 Nevertheless, it has been recently observed that pediatric recipients of livers from cDCD donors have better allograft and patient survival than adult recipients. 24,26 Liver acceptance in our study was high, with 85% livers recovered and transplanted and no livers discarded during the recovery procedure.…”

Use of DCD organs: Expanding the donor pool to increase pediatric transplantation

“…Furthermore, outcomes from pediatric DCD donors also have excellent outcomes. Little et al 20 found that although pediatric DCD livers are procured at a lower rate than their adult counterparts, the outcomes are comparable. In addition, recovery rates of younger donors (0–12 years) were significantly lower than donors aged 13‐17 years.…”