Graft survival in pediatric liver transplantation

Background/Purpose: Liver transplantation is standard therapy for children with a variety of liver diseases. The current shortage of organ donors has led to aggressive use of reduced or split grafts and living-related donors to provide timely liver transplants to these children. The purpose of this study is to examine the impact of these techniques on graft survival in chi ldren currently treated with liver transplantation. Methods: Data were obtained on all patients less than 21 years of age treat ed with isolated liver transplants performed after January 1, 1996 in an in tegrated statewide pediatric liver transplant program, which encompasses 2 high-volume centers. Nonparametric tests of association and life table anal ysis were used to analyze these data (SAS v 6.12). Results: One hundred twenty-three children received 147 grafts (62 at the U niversity of Florida, 85 at the University of Miami). Fifty-two (36%) child ren were less than 1 year of age at time of transplant, and 80 (55%) were l ess than 2 years of age. Patient survival rate was identical in the 2 cente rs (1-year actuarial survival rate, 88.4% and 87.1%). Twenty-five (17%) gra fts were reduced, 28 (19%) were split, 6 were from living donors (4%), and 88 (60%) were whole organs. One-year graft survival rate was 80% for whole grafts, 71.6% for reduced grafts, and 64.3% for split grafts (P = 06). Chil dren who received whole organs (mean age, 6.1 years) were older than those who received segmental grafts (mean age, 2.5 years; P <.01). Multifactorial analysis suggested that patient age, gender, and use of the graft for retr ansplant did not influence graft survival, nor did the type of graft used i nfluence patient survival. Conclusions: The survival rate of children after liver transplantation is e xcellent independent of graft type. Use of current techniques to split graf ts between 2 recipients is associated with an increased graft loss and need for retransplantation. Improvement in graft survival of these organs could reduce the morbidity and cost of liver transplantation significantly in ch ildren. J Pediatr Surg 36:1205-1209. Copyright (C) 2001 by W.B. Saunders Co mpany.