Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

Abstract

BackgroundLiver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD) donors.MethodAll transplantations performed with a liver from a pediatric donor (≤16 years) in the Netherlands between 2002 and 2015 were included. Patient survival, graft survival, and complication rates were compared between DCD and DBD liver transplantation.ResultsIn total, 74 liver transplantations with pediatric grafts were performed; twenty (27%) DCD and 54 (73%) DBD. The median donor warm ischemia time (DWIT) was 24 min (range 15–43 min). Patient survival rate at 10 years was 78% for recipients of DCD grafts and 89% for DBD grafts (p = 0.32). Graft survival rate at 10 years was 65% in recipients of DCD versus 76% in DBD grafts (p = 0.20). If donor livers in this study would have been rejected for transplantation when the DWIT ≥30 min (n = 4), the 10-year graft survival rate would have been 81% after DCD transplantation. The rate of non-anastomotic biliary strictures was 5% in DCD and 4% in DBD grafts (p = 1.00). Other complication rates were also similar between both groups.ConclusionsTransplantation of livers from pediatric DCD donors results in good long-term outcome especially when the DWIT is kept ≤30 min. Patient and graft survival rates are not significantly different between recipients of a pediatric DCD or DBD liver. Moreover, the incidence of non-anastomotic biliary strictures after transplantation of pediatric DCD livers is remarkably low.

First report of successful transplantation of a pediatric donor liver graft after hypothermic machine perfusion

“…For children, the use of DCD grafts is still controversial and the available data are limited to small series. 3,4 To improve outcome of DCD liver transplantation, ex situ HMP is increasingly used as an alternative strategy for organ preservation, with the supplemental value of providing oxygen to the graft during preservation. 5 The initial experience in adults has demonstrated that end-ischemic HMP provides better preservation of DCD liver grafts.…”

“…This case report describes the first successful transplantation of a pediatric DCD liver graft after ex situ oxygenated HMP. There are only a few descriptions of pediatric liver transplantations with grafts from DCD donors in the current literature 3,4,9. Hong et al reported a matched case-control study of 7 DCD liver transplantations in pediatric patients with excellent long-term outcomes 3.…”

“…Also Gozinni et al have suggested that liver grafts from young DCD donors with short ischemia times can be safely used in pediatric transplantation 9. Moreover, van Rijn et al demonstrated that transplantation of pediatric DCD liver grafts results in good long-term outcomes, when the donor warm ischemia time is kept under 30 minutes 4. Patient and graft survival rates were comparable to those of pediatric donation after brain death liver grafts.Moreover, the incidence of non-anastomotic biliary stricturesF I G U R E 2 Panel A: Serum AST, ALT, ALP, and GGT levels in a 16year-old recipient after successful transplantation of a hypothermic oxygenated machine perfused pediatric DCD liver graft.…”

Expansion of the Pediatric Donor Pool for Liver Transplantation in the United States

“…Despite the increase in ischemic cholangiopathy using DCDD organs, pediatric DCDD OLT's acceptable outcomes warrant its expanded implementation given insufficient DBD organ availability. Providing further justification for the increased use of pediatric DCDD allografts, van Rijn, et al [4] reports equivalent patient and allograft survival rates between recipients of pediatric DCDD (warm ischemia time < 30 minutes) and DBD livers, with comparable incidence of biliary or non-biliary complications.…”

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

“…(21) Although 1 retrospective study reported similar graft and patient survival of pediatric DCD livers when compared with age-matched DBD donors, there remains a paucity of data evaluating the use and overall outcomes of pediatric DCD allografts. (22) The purpose of this study was to examine trends of national DCD allograft recovery and associated longterm outcomes through analysis of the OPTN database and, additionally, to investigate DCD listing and allocation trends relative to age. We hypothesized that younger pediatric DCD livers are being recovered at a disproportionately low rate when compared with matched adult DCD livers.…”