Analysis of survival and morbidity after pediatric liver transplantation with full-size and technical-variant grafts

Background To alleviate the shortage of size-matched whole-donor organs, to o-large-for-size cadaveric donor grafts are modified by liver resection tec hniques. These modifications result in technical-variant liver transplantat ion (TVLTx). Patient and graft survival rates after TVLTx are considered co mparable to those after full-size liver transplantation (FSLTx). However, m orbidity after TVLTx is often underexposed. The aim of this study was to an alyze the results of FSLTk and TVLTx in terms of patient and graft survival rates and morbidity. Methods. A consecutive series of 97 primary and elective pediatric liver tr ansplantations performed in a single center was retrospectively analyzed. F orty-seven children had a FSLTx and 50 a TVLTx (38 reduced-size liver graft s and 12 split-liver grafts). The overall median follow-up period was 3.5 y ears. Results. There were no differences in patient and graft survival rates betw een FSLTx and TVLTx. However, after TVLTx there was a significantly higher complication rate (1.42 vs. 0.81 after FSLTx). TVLTx is more hampered by bi liary complications (30% vs. 17%), expressed by a higher incidence of chola ngitis and leakage of bile. These complications led to a significantly high er incidence of sepsis (44% vs. 19%) and a significantly higher interventio n rate (0.40 vs. 1.28) after TVLTx, There was no difference in the incidenc e of retransplantations between FSLTx and TVLTx. Conclusions. Both FSLTx and TVLTx offer the same prognosis in terms of pati ent and graft survival rates for children after a primary and elective live r transplantation. However, TVLTx has a higher morbidity.