Safety and risk of using pediatric donor livers in adult liver transplantation

Abstract

Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age > 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n ‫؍‬ 70) or adult donors (ADs; age > 19 years; n ‫؍‬ 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n ‫؍‬ 5) versus 0.4 or greater (n ‫؍‬ 56) and less than 0.5 (n ‫؍‬ 21) versus 0.5 or greater (n ‫؍‬ 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9%) compared with the AD group (3.8%; P ‫؍‬ .0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P ‫؍‬ .0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P ‫؍‬ .0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level > 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40%; P < .06), septicemia (60%), and decreased 1-and 5-year graft survival rates (40% and 20%; P ‫؍‬ .08 and .07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0.4 or greater. (Liver Transpl 2001;7:41-47.)

Intrahepatic cholestasis after liver transplantation

“…In a series of 70 livers from pediatric donors (age Ͻ13 years) transplanted in adult recipients, the incidence of arterial thrombosis and graft loss was high when the ratio of donor-liver weight to estimated recipient-liver weight was less than 0.4. 46 In the whole group, cholestasis with bilirubin levels Ͼ5 mg/dL on postoperative day 7 was associated with prolonged cold and warm ischemic times.…”

“…This is indicated clinically by features of cholestasis associated with hyperbilirubinemia, increased prothrombin time, and profuse ascites. 46,47 The diagnosis is based on histologic findings of diffuse ischemic patterns with cellular ballooning, which progress to cholestasis in subsequent biopsies. In a series of 70 livers from pediatric donors (age Ͻ13 years) transplanted in adult recipients, the incidence of arterial thrombosis and graft loss was high when the ratio of donor-liver weight to estimated recipient-liver weight was less than 0.4.…”

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…Reports on eHAT are heterogeneous due to a lack of a commonly accepted definition (18)(19)(20). For example,…”

Doadores limítrofes no transplante de fígado

“…Apesar das constantes variações das estruturas do hilo hepático, principalmente em relação à via biliar e à artéria hepá-tica, estes não representam empecilho técnico para captação do enxerto no doador falecido 44 48,49 (B). O limite máximo é difícil de ser determinado.…”