Objective: Pediatric fulminant hepatic failure (PFHF) is a devastating condition which portends a poor prognosis without liver transplantation (LT). In comparison to adult candidates, there are fewer suitable donor organs from deceased donors (DDLT); this study was conducted to estimate the utility of partial liver grafts (split/reduced [SRLT] and live donors [LDLT]).

Methods: This study used the scientific registry of transplant recipients (SRTR) from 1995-2015, evaluating primary and secondary diagnoses for: acute hepatic necrosis, acute viral hepatitis, toxic insult, and unknown fulminant failure (n= 2419 candidates). Candidate status was evaluated using SRTR delisting codes (n for LT=1339, recovered=632, died=364) and post-LT followup (mean 76.9 months). Cox proportional hazards models using competing risks and the Kaplan-Meier method assessed prognostic outcomes.

Results: From 1995-2015, there was a significant decrease from ~150 to ~75 PFHF per year (P<0.0001). Although waitlist mortality is overall decreasing (19.1% to 9.7%) and successful transplantations increased (53.7% to 62.2%) (Figure 1A, P<0.0001), patients in the <1yo group had persistently high mortality (>20%) compared to the other age groups (P<0.0001). Partial grafts, those most likely to fit pediatric candidates, are underutilized (25.7% of cases). In the adjusted model, amongst other factors, increased age [HR=0.95 per year; P=0.004] and access to partial grafts was significantly associated with decreased risk of waiting list mortality [HR=0.67; P=0.040]. LDLT recipients had shorter median waiting times compared to deceased donors (3 days-LDLT vs 4-DDLT vs 5-SRLT; P=0.017). Patients receiving partial grafts had similar 5-year graft survival compared to whole DDLT (Figure 1B, 78.3% for LDLT, 70.9% for DDLT, 72.1% for SRLT).

Conclusions: PFHF patients <1yo remain disadvantaged due to difficulty with finding a suitable donor organ. In these patients, listing at centers with experienced partial graft programs improved outcomes (both pre- and post-LT). Partial grafts should be sought early, not delayed in hopes of a suitable deceased donor.

CITATION INFORMATION: Firl D., Sasaki K., Quintini C., Eghtesad B., Miller C., Hashimoto K. Survival Benefit of Partial Grafts in Pediatric Candidates with Acute Liver Failure Awaiting Liver Transplantation: SRTR Analysis over 26 Years Am J Transplant. 2017;17 (suppl 3).

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