Introduction: Utilization of pediatric donor organs for adult transplant has emerged in recent years in response to organ shortage. In this study, we investigate recipient and allograft survival in adult recipients of pediatric donor livers. We hypothesize that early failure is common due to vascular issues driven by size mismatch.

Methods: The OPTN/UNOS STAR (Standard Transplant Analysis and Research) file was queried for all isolated liver transplants with donor age <20 and recipient age >18. Out of 247,723 records, 19,359 pairs were suitable for analysis. Cohorts were separated based on donor age in 5-year increments across donor age 0-19 years old. One-way ANOVA was used to compare means across groups. Unadjusted overall and graft survival were assessed using the Kaplan-Meier analysis with log rank test used to compare. Multivariable analysis was conducted using the Cox Proportional Hazard Model. All statistical calculations were completed in SPSS version 24 (IBM).

Results: Based the inclusion criteria cohorts were donors aged 0-4 in group 1 (N=64); age 5-9 group 2 (N=1015); age 10-14 group 3 (N=3881); and age 15-19 group 4 (N=14,399). Unadjusted patient (log rank p=.005) and graft (log rank p=<.0001) survival were decreased in those recipients receiving organs from donors in groups 1 and 2. After adjustment for the following covariates: donor age, recipient age, MELD, BMI, and cold ischemic time; older donor age was associated with improved survival. (HR 0.985 95% CI 0.971-0.999 p = 0.034).

Conclusion: Pediatric liver grafts from donors younger than 10 years old are associated with impaired graft survival when transplanted into adult recipients.

CITATION INFORMATION: Yerxa J., Gao Q., Scheuermann U., Davis R., Vikraman D., Barbas A. Outcomes of Pediatric Donor Liver Grafts for Adult Transplantation: A National Analysis Am J Transplant. 2017;17 (suppl 3).

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