Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis

Barbetta, Arianna; Butler, Chanté; Barhouma, Sarah; Hogen, Rachel; Rocque, Brittany; Goldbeck, Cameron; Schilperoort, Hannah; Meeberg, Glenda; Shapiro, James; Kwon, Yong; Kohli, Rohit; Emamaullee, Juliet

doi:10.1097/txd.0000000000001219

Cited by 32 publications

(45 citation statements)

References 56 publications

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“…27 The same study showed that LDLT recipients had a higher PELD score than DDLT recipients, echoing what we observed in the current study, where PELD score of maternal-LLD recipients is higher compared to DDLT recipeints. 27 The reduced likelihood of ACR in LDLT recipients was also described in the recent study by Przybyszewski et al, where multivariable analysis showed that LDLT was associated with a significantly lower risk of ACR (HR 0.53). 28 However, this study also described a lower incidence of ACR in maternal liver graft recipients when compared to paternal liver graft recipients, which was not supported by our findings.…”

Section: Discussionsupporting

confidence: 89%

“…This is congruent with a previous multicenter study of pediatric LT recipients that reported that the percentage of children free of rejection in the first year post‐LT was higher in LDLT than DDLT recipients, regardless of their PELD/MELD score 9 . Our recent meta‐analysis comparing pediatric LDLT versus DDLT recipients showed that the odds ratio for ACR in LDLT recipients was almost half of that of DDLT recipients (OR 0.66, 95% CI 0.45–0.96, p = 0.03) 27 . The same study showed that LDLT recipients had a higher PELD score than DDLT recipients, echoing what we observed in the current study, where PELD score of maternal‐LLD recipients is higher compared to DDLT recipeints 27 .…”

Section: Discussionmentioning

confidence: 93%

“…Our recent meta‐analysis comparing pediatric LDLT versus DDLT recipients showed that the odds ratio for ACR in LDLT recipients was almost half of that of DDLT recipients (OR 0.66, 95% CI 0.45–0.96, p = 0.03) 27 . The same study showed that LDLT recipients had a higher PELD score than DDLT recipients, echoing what we observed in the current study, where PELD score of maternal‐LLD recipients is higher compared to DDLT recipeints 27 . The reduced likelihood of ACR in LDLT recipients was also described in the recent study by Przybyszewski et al, where multivariable analysis showed that LDLT was associated with a significantly lower risk of ACR (HR 0.53) 28 .…”

Section: Discussionmentioning

confidence: 98%

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Immunologic benefits of maternal living donor allografts in pediatric liver transplantation: fewer rejection episodes and no evidence of de novo allosensitization

Barbetta

Meeberg

Rocque

et al. 2021

Pediatric Transplantation

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Background Pediatric liver transplant (LT) recipients of maternal living liver donor (LLD) grafts have been reported to experience fewer rejection episodes. However, it is unclear whether this benefit translates to reduction in developing donor‐specific antibody (DSA) among maternal‐LLD recipients. The aim of this study was to compare immunologic outcomes among maternal‐LLD, non‐maternal‐LLD, and deceased donor liver transplant (DDLT) recipients. Methods Children (≤18 years) who underwent LT between 1/1998 and 12/2019 at two high‐volume LT centers in North America were evaluated. Patients were divided into three groups by type of graft received (maternal‐LLD, non‐maternal LLD, and DDLT). Clinical variables and outcomes were compared according to each graft type. Results A total of 450 pediatric primary LT were analyzed: 275 (61.1%) DDLT, 73 (16.2%) maternal‐LLD, and 102 (22.6%) non‐maternal‐LLD. Children receiving LLD grafts were less likely to develop rejection when compared to the DDLT group (DDLT 46.9% vs. maternal‐LLD 31.5% vs. non‐maternal‐LLD 28.4%, p = 0.001). There was no difference in rejection rates between maternal and non‐maternal‐LLD recipients. A higher percentage of maternal‐LLD recipients were on immunosuppression monotherapy compared to non‐maternal‐LLD and DDLT recipients (6.7% vs. 1.2 vs. 2.4%, respectively). A subgroup of 68 patients were tested for DSA post‐LT. Maternal‐LLD recipients were less likely to develop de novo DSA (maternal‐LLD 11.8% vs. non‐maternal‐LLD 19.3% vs. DDLT 43%, p = 0.018). None of the maternal‐LLD recipients developed antibody‐mediated rejection. Conclusions These data support the concept of immunologic benefit of maternal‐LLD in pediatric LT, with lower rates of rejection and allosensitization post‐LT when compared to DDLT recipients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

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Immunologic benefits of maternal living donor allografts in pediatric liver transplantation: fewer rejection episodes and no evidence of de novo allosensitization

Barbetta

Meeberg

Rocque

et al. 2021

Pediatric Transplantation

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“…With respect to LDLT, we could additionally show better graft and patient survival in recipients of LDLT, with recent 1-year patient survival rates of 92%. This is no novelty and has been described previously; however, our results encourage the option for LDLT, if available [30][31][32].…”

Section: Discussionsupporting

confidence: 70%

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Moosburner

Wiering

Gül‐Klein

et al. 2022

JCM

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Background: Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center. Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité – Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991–2004, 2005–2014 and 2015–2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board. Results: Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12% (n = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days. Conclusion: The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.

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“…Three different reports by three different working groups have demonstrated almost zero survival of patients who have this histological subtype [74][75][76] . Under this prism, many symposia have been held to create an international consensus for the classification of these tumors [77] , and thus future research should also focus on evaluating the outcomes of children with hepatoblastoma by histologic subtype.…”

Section: Development Of New Biomarkers and Future Directionsmentioning

confidence: 99%

Liver transplantation for hepatoblastoma

Varvoglis¹,

Ziogas²,

Tsoulfas³

2022

Hepatoma Res

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Liver transplantation is the only potentially curative option for unresectable hepatoblastoma. The introduction of platinum-based chemotherapy drastically improved the survival outcomes of patients with hepatoblastoma. However, the use of neoadjuvant chemotherapy and the optimal number of cycles required in patients listed for liver transplantation, as well as the potential use of adjuvant chemotherapy, remain unclear. Additionally, the shortage of donor liver grafts, along with the lack of clear consensus on the management of metastatic hepatoblastoma, makes the decision on whether to proceed to liver transplantation even more complex and challenging. Technological advances may optimize intraoperative imaging of both the primary tumor and metastatic sites, thus facilitating complete resection. Such improvements, along with the wider use of social media platforms to increase public awareness, could potentially pave the way for more optimal implementation of liver transplantation for the treatment of patients with unresectable hepatoblastoma.

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Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 32 publications

References 56 publications

Immunologic benefits of maternal living donor allografts in pediatric liver transplantation: fewer rejection episodes and no evidence of de novo allosensitization

Immunologic benefits of maternal living donor allografts in pediatric liver transplantation: fewer rejection episodes and no evidence of de novo allosensitization

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Liver transplantation for hepatoblastoma

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