Introduction: Multiple strategies exist to increase the organ pool for livers in pediatric recipients, including using split livers, high risk livers, and donation after cardiac death (DCD) livers. Despite the organ shortage, there still remains a relative reluctance to use livers from DCD donors. We examined if this reluctance is warranted by evaluating long term patient and allograft outcomes in pediatric liver transplant recipients.

Methods: The United Network for Organ Sharing database was queried to examine outcomes in all liver transplant recipients from 1993 to 2017. The patients were then divided upon adult and pediatric (under age 18 years) status, donation after brainstem death (DBD) vs. DCD allograft status, and era of transplant (prior to 2006 vs. after 2006). Donor and recipient demographic data were examined, and patient and allograft survival were calculated. Kaplan Meier survival curves were generated. Categorical differences were compared using the unpaired Student's t-test and nominal variables using either the Chi Square or Fischer's exact test. A p-value of <0.05 was considered to be significant.

Results: 57 pediatric liver transplant recipients received a DCD liver allograft over this time period. Those who received DBD livers were younger in age (4.9 years vs. 8.3 years). The average Pediatric End-Stage Liver Disease score was 14 in the DBD group vs. 20 in the DCD group. Patients were of comparable illness in both groups when comparing need for life support at the time of transplant in the DBD vs. DCD groups (9.7% vs. 12.5%). Upon comparison of DBD to DCD liver transplant recipients performed after 2006, there were no statistically significant differences in patient or allograft survival. When comparing recipients transplanted prior to 2006, there were no statistically significant differences in patient or allograft survival. Finally, comparison of pediatric DCD liver transplant recipients prior to and after 2006 also had no statistically significant difference between the two groups. It is interesting to note that in the DCD liver transplant group performed after 2006, there were no biliary complications found.

Conclusion: Pediatric liver transplant recipients of DCD allografts have comparable patient and liver allograft survival when compared to DBD liver allograft recipients. Usage of DCD allografts in the pediatric liver transplant population should be strongly considered to increase the donor organ pool.

CITATION INFORMATION: Hwang C., Levea S., MacConmara M. Should More Donation after Cardiac Death Livers Be Used in Pediatric Transplantation? Am J Transplant. 2017;17 (suppl 3).

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