Frequency of Whole-Organ in Lieu of Split-Liver Transplantation over the Last Decade: Children Experienced Increased Wait Time and Death

P. Valentino,¹ S. Emre,² L. Li,³ Y. Deng,³ G. Gan,³ D. Mulligan,² U. Ekong,¹ M. Rodriguez-Davalos.⁴

¹Pediatrics, Hepatology, Yale University, New Haven, CT
²Surgery, Transplant, Yale University, New Haven, CT
³Yale Center for Analytical Sciences, Yale University, New Haven, CT
⁴Surgery, Transplant, Primary Children's Hospital, Salt Lake City, UT.

Meeting: 2018 American Transplant Congress

Abstract number: 360

Keywords: Outcome, Pediatric, Split-liver transplantation, Waiting lists

Session Information

Session Name: Concurrent Session: Liver: Pediatrics

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 4:54pm-5:06pm

Location: Room 608/609

Background: Organ shortage is a barrier in liver transplantation (LT). Split liver transplantation (SLT) increases organ utilization where a donor provides segmental grafts to 2 recipients. Based on OPTN data supplied by UNOS, we sought to ascertain the number of whole-organ LT (WLT) between 2007-2017 that could have been safely split to 2 recipients, and the pediatric waitlist consequences.

Methods: Deceased donor (DD) suitability to split: ≥12y,<40y, donation after brain death, admitted for≤5d, last serum sodium (Na)≤150 mmol/L, maximum ALT/AST≤120 IU/L, BMI≤28, macrovesicular steatosis<15%, low dopamine/dobutamine rate, no nor/epinephrine use, no extracranial cancer, donor-recipient distance<1000 miles. Recipients who received organs from above DD as a WLT, were narrowed according to: liver-only, ≥12y, segmental graft acceptable at listing, MELD≤30 & not status 1A, BMI<35, and in order to be fair to adult recipients, extended right lobe graft volume calculated by graft-recipient weight ratio>1%. From the match runs of suitable DD/WLT-recipients, the next potential SLT pediatric recipient (PedR) was identified: <5y OR ≥5y and <12y with graft-recipient weight ratio>0.5%, ABO match.

Results: Of 194,695 DD, 1818 DD were suitable to split, and 588 WLT recipients could have accepted SLT; 513 had a suitable PedR who could have accepted a segment graft. A total of 274 PedR who were next on the match run, but did not undergo SLT due to lack of sharing, had longer average wait-time to transplant compared to 1644 pediatric SLT recipients during this time frame (mean 615d vs 115d, P<0.001). These children waited an additional 199d on average following the first DD match run that was transplanted as a WLT instead of SLT. As a result 17 (6%) expired after an average 283d on the waitlist; 169 (62%) had LT.

Conclusions: Given the current organ shortage, sharing organs suitable for splitting will increase the number of LT in children, thus saving more lives. With increased widespread proficiency in SLT adults will also see benefit from use of extended right lobes.

CITATION INFORMATION: Valentino P., Emre S., Li L., Deng Y., Gan G., Mulligan D., Ekong U., Rodriguez-Davalos M. Frequency of Whole-Organ in Lieu of Split-Liver Transplantation over the Last Decade: Children Experienced Increased Wait Time and Death Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Valentino P, Emre S, Li L, Deng Y, Gan G, Mulligan D, Ekong U, Rodriguez-Davalos M. Frequency of Whole-Organ in Lieu of Split-Liver Transplantation over the Last Decade: Children Experienced Increased Wait Time and Death [abstract]. https://atcmeetingabstracts.com/abstract/frequency-of-whole-organ-in-lieu-of-split-liver-transplantation-over-the-last-decade-children-experienced-increased-wait-time-and-death/. Accessed May 12, 2025.

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