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

Pediatric donor (PD) livers have been allocated to adult transplant recipie nts in certain situations despite size discrepancies. We compared data on a dults (age greater than or equal to 19 years) who underwent primary liver t ransplantation using livers from either PDs (age < 13 years; n = 70) or adu lt donors (ADs; age <greater than or equal to> 19 years; n = 1,051). We als o investigated the risk factors and effect of prolonged cholestasis on surv ival in the PD group. In an attempt to determine the minimal graft volume r equirement, 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 di fferent cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n 56) a nd 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 s howed that preoperative prothrombin time of 16 seconds or greater (relative risk 3.206; P =.0115) and absence of FK506 use as a primary immunosuppress ant (relative risk, 4.477; P =.0078) were independent risk factors affectin g 1-year graft survival in the PD group. In the PD group, transplant recipi ents who developed cholestasis (total bilirubin level greater than or equal to 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemi c times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a t rend 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 l ivers for adult recipients was associated with a greater risk for developin g 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 t o be a DLW/ERLW of 0.4 or greater.