Clinical

Living donor liver transplantation linked to better survival in children

Last Updated: 2005-05-18 15:30:39 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In pediatric recipients, living donor liver transplantation (LDLT) is associated with improved survival compared with deceased organ transplantation, new research indicates, and several factors may contribute to the advantage seen with LDLT.

The donor type per se may not be responsible for the survival difference. Instead, it seems to stem from inherent characteristics of LDLT recipients and the operation itself. For example, LDLT recipients are often less ill than their counterparts who receive deceased donor grafts, and the living donor grafts typically have shorter cold and warm ischemia times.

The findings, which appear in the Archives of Surgery for May, are based on an analysis of data from all 8771 pediatric liver recipients entered in the United Network for Organ Sharing (UNOS) database between October 1, 1987 and May 24, 2004.

In agreement with earlier reports, graft and patient survival rates were significantly higher in LDLT recipients compared with recipients of deceased whole or split organ grafts (p < 0.01), lead author Dr. Mary T. Austin and colleagues, from Vanderbilt University in Nashville, Tennessee, note.

For example, 5-year patient survival rates were 78% for the cohort overall, but 84% among those receiving a living donor graft.

Determinants of graft and patient survival included recipient age, race, origin of liver disease, various pretransplantation laboratory results, general medical status, multiorgan transplantation, retransplantation, ABO blood compatibility, and cold/warm ischemia times.

As noted, graft type per se did not seem to have a major impact on survival.

"Although LDLT poses risk to the donor, it is, as practiced, a valuable technique in pediatric transplantation to help overcome the critical organ shortage," the investigators conclude.

Arch Surg 2005;140:465-471.