Pediatric liver transplantation with cadaveric or living related donors: Comparative results in 90 elective recipients of primary grafts

Study design: Between July 1993 and March 1997, 110 children were listed fo r primary elective liver transplantation with cadaveric (Cad: n = 68) or li ving-related (LR: n = 42) donors. Pregraft mortality, post-transplant survi val, and surgical and immunologic complications were retrospectively compar ed in both groups. Results: The pregraft mortality rate was 10 (15%) of 68 versus 1 (2%) of 42 in the Cad and LR groups, respectively (P = .049). Post-liver transplantat ion 1-year patient and graft survival rates were 87% and 75% in the Cad gro up (n = 49) versus 92% and 90% in the LR group (n = 41), respectively (NS). The incidence of post-transplant complications was as follows: hepatic art ery thrombosis (Cad: 16%; LR: 0%, P = .020), portal vein thrombosis (Cad: 8 %; LR: 2%, NS), and biliary complications (Cad: 14%; LR: 34%, P = .044). Th e overall incidence of acute rejection was similar in both groups; however, a lower incidence of acute rejection occurred in LR graft recipients treat ed with tacrolimus. Conclusions: The introduction of an LR donor liver transplantation program allowed a significant decrease in the pretransplant mortality rate, with a consequent overall improvement in patient survival compared with the Cad se ries. The incidence of biliary complications was higher in the LR series, w hereas better human leukocyte antigen matching in this subgroup did not res ult in a lower rejection incidence.