Date: Tuesday, June 5, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Room 6B
Background and Aim: The reported outcomes of adult liver transplantation using pediatric allografts are largely controversial based on single center studies. We aimed to compare outcomes of adult transplantation using pediatric versus adult donor liver grafts by analyzing a nationwide database. Methods: Retrospective analysis of the Scientific Registry of Transplant Recipients data from March, 2002 to December, 2014 identified 1148 liver transplants with pediatric donor livers (PD group, donor age ≤13 years), and 60362 transplants with adult donor livers (AD group, donor age≥18 years). The graft and patient survival were compared using Kaplan-meier analysis. Results: The adjusted 10-years graft survival rates were significantly higher in PD recipients than in AD recipients (P<0.001). Donor aged 0-6 years, cold ischemia time ≥12 hours, BSAi < 0.78, recipients with serum creatinine ≥1.5mg/dL pretransplant, and ventilator use pretransplant were the independent risk factors of graft loss in adult liver transplant recipients using pediatric donor organs. Based on multivariate analysis of risk factors of graft loss, we established a risk scoring model with excellent stratification of prognostic subgroups (AUC, 0.785; 95% CI, 0.731–0.839).
|Table 1. Multivariate analysis of 1-year graft failure for pediatric donor group and assigned risk score points|
|Variables||Hazard ratio||95% CI||P values||Risk score points|
|Cold ischemia time ≥ 12hours (vs. < 12 hours)||1.999||1.211-3.302||0.007||7|
|BSAi < 0.78 (vs. ≥ 0.78)||1.425||0.995-2.042||0.050||4|
|Donor age ( years): 0-6 (vs. 7-13)||1.708||0.992-2.939||0.043||5|
|Recipient serum creatinine ≥ 1.5mg/dL (vs. <1.5mg/dL)||1.495||1.031-2.168||0.034||4|
|Recipient ventilator use pretransplant: yes (vs. no)||2.100||1.252-3.524||0.005||7|
The 3-month and 1-year graft survival rates were significantly higher in low risk (91%, 88%) and medium risk (84%, 79%) group than those in high risk (78%, 70%) group (P<0.001). Conclusions: The use of pediatric donors in adult patients yields a better outcome compared with adult-to-adult liver transplantation. A risk-stratification model has been established to allow for better utilization of the scarce resource of pediatric donor liver.
CITATION INFORMATION: Tang Y., Zhao Q., Zhang Z., Wang L., Ju W., Zhu Z., Huang S., Guo Z., He X., Chen G. Liver Transplantation Using Pediatric versus Adult Donor Grafts in Adult Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Tang Y, Zhao Q, Zhang Z, Wang L, Ju W, Zhu Z, Huang S, Guo Z, He X, Chen G. Liver Transplantation Using Pediatric versus Adult Donor Grafts in Adult Recipients [abstract]. https://atcmeetingabstracts.com/abstract/liver-transplantation-using-pediatric-versus-adult-donor-grafts-in-adult-recipients-2/. Accessed January 18, 2021.
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