Background: While there is an agreement that pediatric donor (PD) livers should ideally be used for pediatric recipients, there remain some situations where these livers are turned down by the pediatric recipient pool and they are offered to adult recipients. The present study aimed to investigate the outcomes of using PD for liver transplantation (LT) in adult patients.

Methods: Data from all patients undergoing LT between2002-2014 were obtained from the UNOS Standard Analysis and Research file. Adult recipients undergoing LT were divided into 2 groups: those receiving a pediatric donor (peds-to-adult) and those receiving an adult donor (adult-to-adult). Pediatric donors were defined as ≤ 12 years of age and adults were defined as ≥ 18 years of age. A separate subgroup analysis comparing the PD used for adult recipients and those used for pediatric recipients was also performed.

Results: Overall survival and graft survival were not significantly different between the peds-to-adult and adult-to-adult groups (p=0.08 and respectively p=0.21). Hepatic artery thrombosis (HAT) as the cause for graft loss was higher in the peds-to-adult group (3.6%) than the adult-to-adult group (1.9%)(p<0.001). A subanalysis looking at graft survival in the peds-to-adult group found a trend of superior survival in LT with a predicted GRWR ≥ 0.8 compared to LT with a GRWR < 0.8. Pediatric donors used for adult recipients had a higher proportion of donors with elevated AST/ALT (12% vs. 20%; p<0.001), elevated creatinine (4% vs. 11%; p<0.001) DCD donors (9.3% vs. 4.2%; p<0.001) and were hepatitis B core positive (0.3% vs. 1%;p=0.002) than pediatric donors used for pediatric recipients.

Conclusion:Acceptable patient and graft survival can be achieved with the usage of pediatric liver allografts in selected adult recipients, when they have been determined to be inappropriate for usage in the pediatric population.

CITATION INFORMATION: Croome K, Lee D, Burns J, Nguyen J, Perry D, Taner C. Outcomes with the Use of Pediatric Donor Livers in Adult Recipients: Review of the UNOS Database. Am J Transplant. 2016;16 (suppl 3).

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