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Liver Transplantation in Children Using Organ Donation After Circulatory Death– An Analysis of the National Registry

G. El-Gazzaz, K. Hashimoto, M. Fujiki, T. Daigo, C. Quintino, F. Aucejo, D. Kelly, C. Winans, C. Miller, J. Fung, B. Eghtesad.

Liver Transplant and Hepatobiliary, Cleveland, Cleveland, OH.

Meeting: 2015 American Transplant Congress

Abstract number: C113

Keywords: Age factors, Allocation, Donors, Liver, non-heart-beating

Session Information

Date: Monday, May 4, 2015

Session Name: Poster Session C: Liver Donation and Allocation

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Related Abstracts
  • National Outcomes of Donation After Cardiac Death (DCD) Liver Transplantation Are Equivalent to Donation After Brain Death (DBD) Liver Transplantation Using Older (DBD) Donor Livers
  • Assessment of Actual Pediatric Organ Donation Potential: Neurologic and Circulatory Determination of Death at a Children's Hospital

The waiting list mortality rate for children is higher than for adults owing to scarce availability of size-appropriate grafts for liver transplantation(OLT). There is a little experience about using organs donation after circulatory death(DCD) in pediatric recipients.

Aim

To compare the long-term national outcomes for children(aged< 18 years)undergoing OLT using DCD versus organs donation after brain death (DBD). The primary outcome measure was graft failure–free survival; the secondary end point was the frequency of retransplantation.

Methods

All children(< 18 years) undergoing primary OLT from DCD and DBD donors were identified from SRTR database. Patient survival was analyzed using the Kaplan–Meier curve and Cox regression.

RESULTS Between 2000-2013, 7874 pediatric recipients received DBD livers vs 47 children received DCD livers(0.6%). DCD pediatric recipients median weight 27.0 kg (5.3–80) and median BMI 21.9(18.7-24.7). The DCD pediatric recipients were significantly older than DBD recipient, however, there were no significant difference in gender, ethnicity, indication for liver transplant, PELD score, retransplantation and immunosuppression between both groups.

Patients Characteristics
Variables pDCD (n=47) pDBD (n=7874) P value
Age (mean) yrs 6.4±2.5 4.1±1.7 0.001
Male (%) 55% 51% 0.67
Ethnicity (%)     0.35
White 59% 53%  
Black 18% 18%  
Others 23% 29%  
Indication of transplantation     0.72
Biliary Atresia 27% 34%  
Malignant neoplasm 21% 6.5%  
Acute failure 12% 8%  
A-1-A 6% 2.5%  
Others 34% 49%  
PELD score 15 14 0.57
Retransplant 15% 8% 0.19
Immunosuppression     0.2
Tacrolimus 88% 91%  
Median follow-up was 36 months (1.7–68 months). There is no difference in survival between both groups in K-M graph (p=0.7).CONCLUSIONS The national data showed the outcomes of liver transplantation in children using DCD organs were similar to children received DBD organs. The transplant centers appear reluctant to use DCD grafts in the pediatric population, which may ameliorate organ shortage.

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To cite this abstract in AMA style:

El-Gazzaz G, Hashimoto K, Fujiki M, Daigo T, Quintino C, Aucejo F, Kelly D, Winans C, Miller C, Fung J, Eghtesad B. Liver Transplantation in Children Using Organ Donation After Circulatory Death– An Analysis of the National Registry [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplantation-in-children-using-organ-donation-after-circulatory-death-an-analysis-of-the-national-registry/. Accessed January 28, 2021.

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