Results of pediatric living donor compared to deceased donor liver transplantation in the PELD/MELD era: Experience from two centers on two different continents

Abstract

The LDLT option in the pediatric population allows recipients to be transplanted early. A total of 202 consecutive pediatric liver transplants from two different institutions--108 (LDLT) and 94 (DDLT)--were retrospectively compared. Overall, one- and three-yr patient and graft survival were similar between DDLT and LDLT. ACR was greater in recipients of DDLT at one and three yr (50.8% and 61.0%) compared to LDLT (30.8% and 32.2%) (p = 0.002). When the data were stratified according to PELD/MELD score, LDLT with a low score had better one- and three-yr graft survival (96.2% and 96.2%) compared to DDLT (88.2% and 85.2%) (p = 0.02), with comparable patient survival (p = 0.75). Patient and graft survival were similar between DDLT and LDLT in the high PELD/MELD group. Lower incidence of ACR in both low and high PELD/MELD groups was (29.6% and 34.3%) for LDLT compared to DDLT (50.3% and 53.3%, p = 0.002 and p = 0.028, respectively). Regardless of PELD/MELD score, status, age group, and recipient weight, LDLT provides excellent patient and graft survival with a lower incidence of rejection compared to DDLT.

Predicting early outcomes of liver transplantation in young children: The EARLY study

“…Although some reports have found complication rates to have improved over time, these are usually reports from the 1990s, with the improvements seen by the early-to-mid 2000s[ 10 , 11 , 14 , 17 , 18 , 24 , 28 , 31 ]. This is similar to reports that have found that young age and smaller weight is no longer a risk factor for complications[ 2 , 8 , 13 , 14 , 16 - 18 , 22 , 26 , 27 , 29 , 31 ]. Indeed, we did not find that year or weight was an independent predictor of complication rates.…”

“…The rates of HAT, PVT, and bile leak were higher than in most reports. For example, HAT is often in the range of 5%-10% (compared to our rate of 19%)[ 2 , 8 , 11 , 14 , 15 , 17 , 18 , 22 - 27 ], PVT in the range of 5%-15% (compared to our rate of 17%)[ 2 , 11 , 15 - 18 , 24 - 26 , 28 , 29 ], and bile leak in the range of 2%-15% (compared to our rate of 23%)[ 10 , 15 , 16 , 26 , 29 ]. A report from the SPLIT database found high rates of vascular complications (25%), PVT (16%), and bile leak (21%) in the 6.7% of recipients with complex vascular anomalies[ 30 ]; however, we did not find an association of abnormal anatomy comments and thrombosis or severe complications.…”

“…The outcomes among centers are highly variable, with most large centers reporting excellent outcomes[ 11 , 17 , 18 , 24 - 26 , 28 ], and some smaller centers reporting poor outcomes[ 43 - 47 ]. Some authors have reported a decrease in complication rates over time associated with what they call technical experience[ 10 , 17 , 18 , 27 , 29 , 48 ]. The SPLIT group has reported that the center where transplant is done is a predictor of patient and graft survivals (which in turn are predicted by complication rates), and that after adjusting for center there is no effect of age on transplant outcomes[ 13 ].…”

“…Nevertheless, there is conflicting literature. Some groups have reported that graft type is not related to biliary complications[ 10 , 16 , 29 ]. Most groups have reported that graft type is not related to HAT[ 15 ], and UNOS data and some single center data suggests graft survival is better after living donor grafts than deceased donor grafts, particularly in younger patients[ 11 , 27 , 49 , 50 ].…”

Immunologic benefit of maternal donors in pediatric living donor liver transplantation

“…Initially, reported overall graft and patient survival in LDLT compared to DDLT were similar, but more recently, data have suggested that LDLT results in superior outcomes in both adult and pediatric patients. [5][6][7][8][9][10][11] Indeed, in many centers in Asia, Europe, and Canada, the majority of pediatric LT recipients undergo LDLT. 4,[12][13][14][15] The factors which result in superior outcomes with LDLT versus DDLT have not been well characterized.…”