title: Liver transplantation in children using organ donation after circulatory death: a case-control outcomes analysis of a 20-year experience in a single center.
abstract: OBJECTIVE
  While orthotopic liver transplantation (OLT) is a durable life-saving treatment for patients with irreversible liver disease, the waiting list mortality rate for children younger than 6 years is 4 times higher than for children aged 11 to 17 years and adults owing to scarce availability of size-appropriate grafts for transplantation.
  
  
  OBJECTIVE
  To compare long-term outcomes for children (aged ≤18 years) undergoing OLT using grafts from donation after circulatory death (DCD) and donation after brain death (DBD).
  
  
  METHODS
  Retrospective study using case-control matched groups at a university transplant center. All patients aged 18 years and younger who underwent OLT using DCD organs between February 1, 1990, and November 30, 2010, at the University of California, Los Angeles, were matched in a 1 to 3 ratio with patients who received primary OLT from DBD donors within a 12-month period. Other matching criteria included recipient age, weight, cause of liver disease, and acuity of illness. Outcomes after OLT were compared for DCD (n = 7) and DBD (n = 21) donors. The median follow-up was 4.5 years.
  
  
  METHODS
  The primary outcome measure was graft failure-free survival; the secondary end point was the development of ischemic cholangiopathy.
  
  
  RESULTS
  Comparing DCD and DBD groups, recipient median age (28.4 vs 20.1 months, respectively; P = .80), weight (12.0 vs 11.6 kg, respectively; P = .87), Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease score (19 vs 11, respectively; P = .48), and donor age (24.0 vs 13.1 months, respectively; P = .72) were similar. For the DCD donors, the median donor warm ischemia duration was 24 minutes. Liver test results were similar for both groups at 1 week and 3, 6, and 12 months following OLT. Ten-year patient and graft survival rates for both DCD and DBD were 100%. Neither ischemic cholangiopathy nor vascular complications occurred in the DCD group. Biliary anastomotic strictures occurred in 1 DCD patient and 3 DBD patients.
  
  
  CONCLUSIONS
  Our study showed excellent long-term outcomes with liver transplantation in children using DCD organs. Use of liver grafts procured after circulatory death is an effective approach to expand the donor pool and remains an untapped resource for children with end-stage liver disease.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee.
authors.forename: Johnny C
authors.initials: JC
authors.lastname: Hong
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles3Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Robert
authors.initials: R
authors.lastname: Venick
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Prawat
authors.initials: P
authors.lastname: Kositamongkol
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Fady M
authors.initials: FM
authors.lastname: Kaldas
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Vatche
authors.initials: V
authors.lastname: Agopian
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles3Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Sue V
authors.initials: SV
authors.lastname: McDiarmid
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.affiliation: Department of Surgery, Dumont-UCLA Liver Cancer and Transplant Centers, Pfleger Liver Institute, University of California, Los Angeles.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003643:Death; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome