New research reveals that transplantation of partial livers from
deceased adult and teen donors has become less risky for infants and
young children, helping to save these young lives. Findings published
online in Liver Transplantation, a journal of the American
Association for the Study of Liver Diseases and the International Liver
Transplantation Society, indicate that risk of organ failure and
mortality from partial or split liver transplant was comparable to
whole organ transplant in this pediatric population.
Available livers for transplantation are in short supply,
particularly size-matched organs for the youngest patient on the
waitlist. While there is evidence that partial organs donated from
living donors are superior to those from deceased donors, they
accounted for less than 11% of pediatric liver transplants in 2010.
Since 2002, studies show an eight-fold increase in the use of partial
grafts from deceased donors, accounting for up to 32% of liver
transplants in children.
“Infants and young children have the highest waitlist mortality
rates among all candidates for liver transplant,” explains senior
author Dr. Heung Bae Kim, Director of the Pediatric Transplant Center
at Boston Children’s Hospital in Massachusetts. “Extended time on the
liver transplant waitlist also places children at greater risk for
long-term health issues and growth delays, which is why it is so
important to look for methods that shorten the waitlist time to reduce
mortality and improve quality of life for pediatric patients.”
To further understand outcomes of using deceased donor partial
livers in infants, the team identified 2,679 liver transplant
recipients under the age of two in the United Network of Organ Sharing
(UNOS) database from 1995-2010. There were 1,114 partial livers and
1,565 whole organs from deceased donors that were used in the
transplants analyzed. They examined mortality and graft survival over
time.
Graft survival between partial and whole grafts were significantly
different in 1995-2000, but comparable in 2001-2005 and 2006-2010,
suggesting that transplants using partial livers became less risky over
time. Adjusted risk of graft failure and mortality was similar for
partial and whole organs in 2006-2010.
“Infants continue to have twice the mortality rate of adult
candidates on the waitlist,” concludes Dr. Kim. “Our study confirms
that organ failure and mortality risk in the very young was similar for
partial and whole organs from deceased donors. The transplant
community must continue to look for ways to reduce mortality rates in
pediatric patients and using partial livers from deceased, as well as
living donors, may hold the key.”
- Full bibliographic information “Deceased Donor Liver Transplantation in Infants and Small Children: Are Partial Grafts Riskier Than Whole Organs?” Ryan P. Cauley, Khashayar Vakili, Kristina Potanos, Nora Fullington, Dionne A. Graham, Jonathan A. Finkelstein and Heung Bae Kim. Liver Transplantation; (DOI: 10.1002/lt.23667) Online Publication: May 21, 2013, URL: http://doi.wiley.com/10.1022/lt.23667
Source: AlphaGalileo
