Living Donor versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-Analysis of Outcomes

A. Barbetta¹, C. Butler², S. Barhouma², R. Hogen¹, B. Roque¹, H. Schillperoort³, G. Meeberg⁴, J. Shapiro⁵, Y. Kwon¹, R. Kohli⁶, J. Emamaullee¹

¹Surgery, abdominal transplat, University of Southern California, Los Angeles, CA, ²University of Southern California, Los Angeles, CA, ³Norris Medical Library, University of Southern California, Los Angeles, CA, ⁴Department of Surgery, University of Alberta, Edmonton, AB, Canada, ⁵Department of Surgery,, University of Alberta, Edmonton, AB, Canada, ⁶Department of Pediatrics, University of Southern California, Los Angeles, CA

Meeting: 2021 American Transplant Congress

Abstract number: 1162

Keywords: Graft survival, Liver grafts, Split-liver transplantation, Survival

Topic: Clinical Science » Liver » Liver: Pediatrics

Session Information

Session Name: Liver: Pediatrics

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Reduced size deceased donors and living donor liver transplantation (LDLT) can help address the organ shortage for pediatric liver transplant candidates. Concerns regarding technical challenges and the risk of postoperative complications have been raised when using segmental grafts in children, leading to variable practice patterns in utilization of these grafts. We sought to compare outcomes for pediatric LDLT and DDLT via systematic review and meta-analysis.

*Methods: A systematic literature search was performed to identify studies reporting outcomes of pediatric (<18 year) LDLT and DDLT published between 2005-2019. Unpublished data from an additional high-volume Canadian center were included. Perioperative and survival outcomes were pooled and compared using fixed- and random-effects models.

*Results: Overall, 2518 abstracts were screened, and 10 studies met criteria for inclusion. In total, 1622 pediatric LDLT and 6326 pediatric DDLT patients from four continents were examined. LDLT recipients had superior overall survival when compared to DDLT recipients at 1, 3, and 5-years post-LT [1year HR: 0.56 CI 95% 0.45-0.71, p<0.0001] (Fig 1A). Similarly, LDLT resulted in superior graft survival at all time points post-LT when compared to DDLT [ 1-year graft survival, HR: 0.47 95% CI: 0.37-0.61, p<0.0001] (Fig 1B). LDLT was associated with higher PELD at LT. There was no difference in the rate of post-LT vascular or biliary complications, while LDLT was associated with lower rates of acute cellular rejection [OR: 0.66 (95% CI: 0.45-0.96), p=0.03] (Fig 1C).

*Conclusions: Our global meta-analysis demonstrates that LDLT offers many advantages when compared to DDLT in children and suggests that LDLT should continue to be expanded to optimize outcomes in pediatric liver transplant recipients.

To cite this abstract in AMA style:

Barbetta A, Butler C, Barhouma S, Hogen R, Roque B, Schillperoort H, Meeberg G, Shapiro J, Kwon Y, Kohli R, Emamaullee J. Living Donor versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-Analysis of Outcomes [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/living-donor-versus-deceased-donor-pediatric-liver-transplantation-a-systematic-review-and-meta-analysis-of-outcomes/. Accessed November 21, 2024.

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