28-Year Cumulative US Experience with Pediatric Living Donor Liver Transplant

28-Year Cumulative US Experience with Pediatric Living Donor Liver Transplant – How Far Have We Come?

S. Sharma, K. Barrera, A. Gruessner, R. Gruessner.

Surgery, State University of New York, Downstate, Brooklyn, NY.

Meeting: 2018 American Transplant Congress

Abstract number: B286

Keywords: Living-related liver donors, Pediatric

Session Information

Session Name: Poster Session B: Liver: Pediatrics

Session Type: Poster Session

Date: Sunday, June 3, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Introduction: The last 30 years have shown tremendous growth in pediatric liver transplant. Refinements of surgical technique and immunosuppression have improved graft survival. In the current literature, analysis of outcomes in living donor (LD) pediatric liver recipients after more than 20 years is limited.

Methods: Using the UNOS database, 15,348 pediatric living donor liver recipients were identified between 1987-2015. This 28-year period was divided into 4 eras: 1987-94, 1995-01, 2002-08, and 2009-15. Demographics of donor and recipients were assessed. Overall patient survival and graft function were analyzed using Kaplan Meier.

Results: Median recipient age was 1 year and did not fluctuate through subsequent eras. Average MELD score increased from 3.8 to 17.3-17.4. The number of biological parental, blood related donors gradually decreased from 86.1% (1987-1994) to 63.25% (2009-2015). Conversely, non parental biological donors increased from 3.9% (1987-1994) to 15% (2009-2015) and non-biological unrelated anonymous donors, also increased from 0% to 3.25% respectively. Overall survival and graft function improved progressively throughout the eras. (Table 1) The most common cause for transplantation was biliary atresia throughout all eras, followed by cirrhosis and metabolic disease. Patients were more likely to receive living donor transplants if they were not on hemodialysis (OR 4.1, CI 1.4-11.5). Patients with AB type blood were less likely (OR 0.2, CI 0.1-0.5). Analysis of pediatric living liver donor transplantation geographically demonstrated that regions 1, 2, 9 had more transplantations.

Era	1 yr	5yr	10yr	p value
1987-1994 DD LD	– 74.2% 78.9%	– 67.9% 67.7%	– 62.7% 61.6%	0.59
1995-2001 DD LD	– 80.5% 80.7%	– 72% 74.7%	– 66.6% 70.3%	0.08
2002-2008 DD LD	– 86.7% 87.1%	– 72% 74.7%	– 66.6% 70.3%	0.02
2009-2015 DD LD	– 89.9% 92.7%	– 85% 86.8%	–	0.13

Era

1 yr

5yr

10yr

p value

1987-1994

–

74.2%

78.9%

–

67.9%

67.7%

–

62.7%

61.6%

0.59

1995-2001

–

80.5%

80.7%

–

72%

74.7%

–

66.6%

70.3%

0.08

2002-2008

–

86.7%

87.1%

–

72%

74.7%

–

66.6%

70.3%

0.02

2009-2015

–

89.9%

92.7%

–

85%

86.8%

–

0.13

Conclusion: This study is one of the first analyses of living donor liver transplant in the pediatric population with more than 20 year followup. While most recipients are still ~1 year of age, an increasing number of higher MELD patients are being transplanted. Additionally, increasing non parental living donors are providing organs. Overall and graft survival has improved over the years. Disparities in access to living donor transplant warrants further evaluation.

CITATION INFORMATION: Sharma S., Barrera K., Gruessner A., Gruessner R. 28-Year Cumulative US Experience with Pediatric Living Donor Liver Transplant – How Far Have We Come? Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Sharma S, Barrera K, Gruessner A, Gruessner R. 28-Year Cumulative US Experience with Pediatric Living Donor Liver Transplant – How Far Have We Come? [abstract]. https://atcmeetingabstracts.com/abstract/28-year-cumulative-us-experience-with-pediatric-living-donor-liver-transplant-how-far-have-we-come/. Accessed November 24, 2024.

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