[Expanding the grafts pool for pediatric liver transplantation with segmental grafts from living donor and cadaveric reduced size or split grafts].
OBJECTIVE
To compare short and long-term results of pediatric liver transplantation (LT), utilizing segmental grafts from living donors (LD) vs. cadaveric (CAD) reduced size or split grafts.


METHODS
A retrospective analysis of a single center experience (1993-2000), comparing the surgical outcome, the graft function and the survival rates between these groups.


RESULTS
Of 195 LTs in pediatric recipients (age < 18), 48 (25%) were with LD grafts and 47 (24%) with CAD grafts (reduced size, n = 27, or split, n = 20). The mean age and weight of the LD recipients were 1.8 +/- 3 yrs and 9.0 +/- 8.1 kg vs. 3.5 +/- 4 yrs. and 15.2 +/- 14.5 kg in the CAD group. The distribution of etiologies was comparable (EHBA, 54% vs. 49%; inborn errors in metabolism, 12.5% vs. 12%; acute idiopathic hepatic failure, 12.5% vs. 14.2%). The severity of pretransplant disease and the fraction of acute hepatic failure cases were also comparable, although less LD grafts were used for urgent re-transplantation due to primary non-function or vascular complications (1 case in the LD group vs. 6 in the CAD group). The median warm ischemia time was similar (43 min; range, 28-87 min vs. 45 min; range 12-82 min), but the median cold ischemia time was significantly different (60 min; range 43-298 in LD vs. 637 min; range, 342-1102 in CAD grafts). Both patient and graft survival in 3 months, 1 and 5 years were significantly superior in the LD group (patient survival, 97%, 91% and 89% vs. 82%, 70% and 62%, p < 0.001; graft survival, 92%, 89% and 77% vs. 66%, 59% and 52%, p < 0.005). The incidence of vascular complications (hepatic artery or portal vein thrombosis) and biliary complications (leak of stricture) was comparable (vascular, 10% vs. 7%, biliary, 16% vs. 9%). The incidence of poor early graft function (6% vs. 21%) and primary non-function (2% vs. 18%) was significantly lower in the LD group.


CONCLUSIONS
Although presenting similar surgical complexity, the outcome of segmental grafts from LD is better than of reduced size or split cadaveric grafts.
Department of General Surgery and Transplantations, Sheba Medical Center, Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA.
M
M
Benhaim
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D019520:Living Donors / Q000600:supply & distribution*; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000379:methods*