title: Effects of recipient size and allograft type on pediatric liver transplantation for biliary atresia.
abstract: The majority of pediatric patients with end-stage liver disease receive a transplant with a whole liver (WL) allograft. However, smaller recipients with biliary atresia (BA) may have improved outcomes with deceased donor partial liver (DDPL) or living donor allografts. This study compares the national outcomes for liver transplantation in BA, with attention to the interaction between liver allograft type and recipient size. From January 2, 2002 to December 30, 2014, 2123 pediatric patients underwent a primary liver transplant for BA. The majority of transplants (53%) were performed with a WL allograft. Utilization of a WL allograft increased from 42% of recipients weighing ≤ 7 kg to 74% of recipients weighing > 14 kg. The 1-, 5-, and 10-year graft survival in recipients weighing ≤7 kg was significantly superior for living donor liver transplantation (LDLT) (91%, 88%, 84%) and DDPL allografts (90%, 84%, 77%) compared with WL allografts (79%, 75%, 74%; P = 0.005). The 1-, 5-, and 10-year graft survival in recipients weighing >14 kg trended toward being inferior in recipients of DDPL allografts (85%, 85%, 71%) compared with WL allografts (96%, 91%, 86%; P = 0.06). Furthermore, the incidence of vascular thrombosis was highest in WL (13%) compared with LDLT (6%) and DDPL (5%) recipients ≤ 7 kg (P = 0.002). Liver retransplantation was also highest in WL (16%) compared with LDLT (9%) and DDPL (9%) recipients ≤ 7 kg (P = 0.02). In conclusion, strong consideration should be given to the use of technical variant allografts in small recipients with BA requiring liver transplantation. Liver Transplantation 23 221-233 2017 AASLD.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Sophoclis P
authors.initials: SP
authors.lastname: Alexopoulos
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Victor
authors.initials: V
authors.lastname: Nekrasov
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Shu
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Navpreet
authors.initials: N
authors.lastname: Kaur
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Yuri S
authors.initials: YS
authors.lastname: Genyk
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts / Q000033:anatomy & histology*; D001656:Biliary Atresia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000033:anatomy & histology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D009929:Organ Size; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult