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Reuters Health Information (2013-11-26): Livers from 'donors after circulatory death' work well in children


Livers from 'donors after circulatory death' work well in children

Last Updated: 2013-11-26 16:32:20 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Liver transplant outcomes in children are similar whether organ donation follows circulatory or brain death, a small study suggests.

Writing online in JAMA Surgery, Dr. Johnny C. Hong of the Medical College of Wisconsin, Milwaukee and colleagues note that organs from "donors after circulatory death" (DCD) are being used to decrease the shortage of organs and waiting list mortality. But the approach is controversial. It's shown inferior results in adults, and data in children are limited, the authors say.

To investigate further, the researchers compared seven pediatric patients who received livers from DCD donors between 1990 and 2010 period with 21 matched controls whose organs were procured after brain death.

The median recipient ages were 28 months in the DCD group and 20 months in patients whose livers came from "donors after brain death." (The waiting list mortality for liver transplant candidates under age six is four times higher than for candidates over age 11, the research team notes.)

Mean recipient weight was similar in the two groups (at roughly 12 kg), as were other parameters including severity of liver disease and donor age. In DCD donors, the median donor warm ischemia time was 24 minutes.

Liver function was similar in both groups at multiple points up to one year after transplantation. At a median follow-up of 4.5 years, graft survival was 100% in both groups. There were no cases of primary graft nonfunction, and biliary and vascular complications were infrequent, according to the report.

These findings, say the investigators, "suggest that outcomes after orthotopic liver transplantation using DCD grafts in children differ from those in adults.

However, "there has been reluctance to use this potential organ resource in children. In 2011, only three of 474 children (0.6%) in the United States received orthotopic liver transplantation from DCD donors."

Livers procured after circulatory death, the researchers conclude, are "an untapped resource for children in need of liver transplantation."

Commenting on the findings by email, Dr. Eric S. Orman, a transplant hepatologist at Indiana University in Indianapolis, told Reuters Health, "Despite the known inferior outcomes of DCD organs for adult liver transplant recipients, this study suggests that these organs may be a good option for pediatric patients."

Still, Dr. Orman cautions, "Additional studies are needed, as this study was based on a small number of patients and was from a large volume center with extensive experience with DCD organs and excellent overall outcomes."

Dr. Hong did not respond to requests for comment.


JAMA Surg 2013.

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