Introduction: Orthotopic liver transplantation is a well-established treatment modality for a wide variety of pediatric illness. With its associated technical challenges, paucity of size-matched allografts, and difficult peri- and post-operative management, transplantation in the very small-sized recipient is especially trying. There is currently a dearth of literature examining outcomes in this population.

Purpose: The purpose of this study is to examine access to transplantation as well as compare postoperative survival in small (weight <10 kg) OLT recipients.

Methods: We analyzed all pediatric (<18 years) candidates for liver transplantation in the OPTN database from 2002 to 2013, excluding combined heart-liver (n=14), lung-liver (n=14), and intestine-liver transplants (n=879). For the access analysis, we followed all candidates listed for liver transplant (n=8380) until transplantation. For the survival analysis, we followed all transplanted recipients (n=5489) until death or last known follow up. We used Kaplan-Meier functions for our time-to-event analysis and performed threshold analysis in 1 kg increments.

Results: The transplant rate was 65.5% over the study period. Using threshold analysis we find a significant reduction in the transplant rate from 5 to 4 kg. 3-month survival was 94.6%, 6-month survival was 93.4%, 9-month survival was 92.8%, and 1-year survival was 92.1%. Threshold analysis revealed a significant reduction from 5 to 4 kg. Our survival analysis was unadjusted. 5.9% of recipients were under 5 kg.

Conclusion: Our data suggests patients less than 5 kg have a significantly decreased probability of liver transplantation as well as lower survival in comparison to their larger counterparts. This should be a consideration in both preoperative nutritional optimization as well as recipient selection for OLT.

CITATION INFORMATION: Steen E, Cotton R, Rana A. How Small Is Too Small: A Comparison of Access and Survival by Weight in Pediatric Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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