title: Transplanting whole livers from donors less than 6 kilograms--is it prudent?
abstract: BACKGROUND
  Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared.
  
  
  METHODS
  The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed.
  
  
  RESULTS
  Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7%, 71.4%, 68.4%, and 65.9% at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1%, 78.7%, 77.3%, and 75.4% at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8%, 84.7%, 82.7%, and 80.6% at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4%, 90.7%, 89.6%, and 88.5% at 1, 3, 5, and 10 y.
  
  
  CONCLUSIONS
  Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival.
authors.affiliation: Division of Abdominal Transplantation and Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. Tnnguyen@bcm.edu
authors.forename: N Thao T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Theresa R
authors.initials: TR
authors.lastname: Harring
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
authors.forename: Christine A
authors.initials: CA
authors.lastname: O'Mahony
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology