Outcome of the use of pediatric donor livers in adult recipients

The prolonged waiting time caused by the lack of donor livers leads to an i ncreasing number of terminally ill patients waiting for lifesaving liver tr ansplantation, To rescue these patients, transplant programs are accepting donor organs from the expanded donor pool, using donors of increasingly old er age, as web as from the pediatric age group, often despite significant m ismatch in liver size. We investigated the outcome of 102 consecutive Liver transplantations using pediatric donor livers in adult recipients, One-yea r graft survival using donors aged 12 years or younger (group 1, n = 14) an d donors aged 12 to 18 years (group 2, n = 88) was compared. In addition, r isk factors for graft loss and vascular complications were analyzed. The I- year graft survival rate in adult transplant recipients in group 1 was 64.3 % compared with 87.5% in those in group 2 (P =.015). The main cause of graf t loss was arterial complications, occurring in 5 of 16 transplant recipien ts (31.3%), Major risk factors for graft loss and vascular complications we re related to the size of the donor: age, height and weight, body surface a rea of donor and recipient, and warm ischemic time. We conclude that the ou tcome of small pediatric donor livers in adult recipients is poor, mainly b ecause of the increased incidence of arterial complications. When a pediatr ic donor is used in an adult recipient, ischemic time should be kept to a m inimum and anticoagulative therapy should be administered in the immediate postoperative period to avoid arterial complications. However, because smal l pediatric donors are the only source of lifesaving organs for the infant recipient, the use of small pediatric donor Livers in adults should be avoi ded.