Survival among pediatric liver transplant recipients: impact of segmental grafts.

Authors

• Peter L Abt
• Rachel Rapaport-Kelz
• Niraj M Desai
• Adam Frank
• Seema Sonnad
• Elizabeth Rand
• James F Markmann
• Abraham Shaked
• Kim M Olthoff

Publication/Presentation Date

10-1-2004

Abstract

Segmental liver transplantation with living donor (LD), reduced cadaveric (Reduced), and split cadaveric (Split) allografts has expanded the availability of size-appropriate organs for pediatric recipients. The relevance of recipient age to the selection of graft type has not been fully explored, but could offer the potential to maximize recipient outcome and donor utilization. We conducted a retrospective cohort study among children 12 years of age or less utilizing the United Network of Organ Sharing (UNOS) database. Cox proportional-hazards analysis was used to explore the association of recipient age and graft type to graft and patient survival. Among children < 1 year of age and those 1 to 2 years of age, 3-year LD graft survival was superior to whole cadaveric (CAD) organs, Split grafts, and Reduced grafts (for children < 1 year of age: 79.4 vs. 61.5, 66.0, and 61.1%, respectively, P = .0003; and for children 1-2 years of age: 79.2 vs 66.9, 57.1, and 63.9%, respectively, P = .02). However, in children 3 to 12 years of age, after controlling for multiple donor and recipient factors, LD grafts failed to offer a survival advantage (hazard ratio = .61; 95% confidence interval = .37-1.02) compared to CAD organs. In an adjusted analysis examining patient survival, there appeared to be minimal association between recipient age and graft type. Much of the difference in graft survival could be attributed to events in the perioperative period. In conclusion, LD liver transplantation provides improved graft survival in children 2 years of age or less.

Volume

10

Issue

10

First Page

1287

Last Page

1293

ISSN

1527-6465

Published In/Presented At

Abt, P. L., Rapaport-Kelz, R., Desai, N. M., Frank, A., Sonnad, S., Rand, E., Markmann, J. F., Shaked, A., & Olthoff, K. M. (2004). Survival among pediatric liver transplant recipients: impact of segmental grafts. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 10(10), 1287–1293. https://doi.org/10.1002/lt.20270

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

15376339

Department(s)

Administration and Leadership

Document Type

Article