Outcome of the use of paediatric donor livers in adult recipients: A single Chinese centre experience - 15/10/18

Doi : 10.1016/j.clinre.2018.08.018

Weiqiang Ju ^a,^b,^c,^{^{1
Weiqiang Ju, Cheukfai Li and Chuanzhao Zhang contributed equally to this work and should be considered as co-first authors.}}, Cheukfai Li ^a,^b,^c,^d,^{^{1
Weiqiang Ju, Cheukfai Li and Chuanzhao Zhang contributed equally to this work and should be considered as co-first authors.}}, Chuanzhao Zhang ^a,^b,^c,^e,^{^{1
Weiqiang Ju, Cheukfai Li and Chuanzhao Zhang contributed equally to this work and should be considered as co-first authors.}}, Dicken Shiu-Chung Ko ^f, Dongping Wang ^a,^b,^c, Ming Han ^a,^b,^c, Paul M. Schroder ^g, Xiaoping Wang ^a,^b,^c, Xingyuan Jiao ^a,^b,^c, Linwei Wu ^a,^b,^c, Qiang Tai ^a,^b,^c, Anbin Hu ^a,^b,^c, Yi Ma ^a,^b,^c, Xiaofeng Zhu ^a,^b,^c, Zhiyong Guo ^a,^b,^c,^⁎, Xiaoshun He ^a,^b,^c,^⁎
^a Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, PR China
^b Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, PR China
^c Guangdong Provincial International Co-operation Base of Science and Technology, Guangzhou 510080, PR China
^d Department of Breast Cancer, Cancer Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, PR China
^e Department of General Surgury, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, PR China
^f Departments of Urology and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
^g Department of Surgery, Duke University Medical Center, Durham, NC 27705, USA

^⁎Corresponding authors at: Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Er road, Guangzhou 510080, PR China.Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen UniversityNo. 58 Zhongshan Er roadGuangzhou510080PR China

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Highlights

The use of paediatric donor livers in well-selected adult recipients is a safe procedure, considering there was no suitable paediatric recipient.

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Summary

Background

Paediatric liver allografts sometimes are allocated to adult recipients when there are no suitable paediatric recipients on the waiting list. However, debate exits regarding the reported outcomes of liver transplants using such small grafts.

Methods

Records from adult patients undergoing liver transplantation between February 2010 and January 2016 who received whole grafts from paediatric (≤ 13 years) donors or ideal deceased adult (18–35 years) donors were reviewed. Patient and graft survival, post-transplant liver function, and complications between the two groups were compared.

Results

The baseline characteristics were comparable, except that the paediatric donor allografts had smaller size. The 3-month, 1-year, and 3-year rates of patient survival were 91.3%, 85.2%, and 85.2% in the paediatric donor group and 93.4%, 88.9%, and 85.0% in the adult donor group (P = 0.947), respectively. One patient receiving a paediatric allograft developed small-for-size liver syndrome post-transplantation. There was no difference in primary non-function, early allograft dysfunction, biliary complications, vascular complications, or infection between the two groups.

Conclusion

Our study indicates that using paediatric donor livers in well-selected adult recipients is a safe procedure, considering there was no suitable paediatric recipient. However, the risk of portal hyperperfusion should be considered in clinical cases such as size-mismatched transplants.

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Abbreviations : PD, AD, TB, ERLW, RBC, DBD, DCD, DBCD, MELD, ICU, GW, RW, IVC, WIT, CIT, PNF, EAD, SFSS, HAT, UNOS, ALT, AST, INR