Background
Pediatric liver transplantation (PLT) progressed extensively over the last few decades due to surgical, medical, and immunosuppression advancements. The only limiting factor for extension of PLT services is the limited number of available grafts. The sources of liver grafts include living and deceased donors. This study was conducted to compare the outcomes of both graft sources and to record short-term and intermediate-term living donor morbidity or mortality.
Patients and methods
This is a review of primary PLT recipients in Leeds Teaching Hospitals NHS Trust. Patients were divided into either recipients of cadaveric or living donor liver graft. Eighteen peritransplant parameters were recorded and classified into pretransplant recipients as well as donor parameters, operative parameters, and posttransplant outcomes. The primary endpoints of this analysis are the incidence of posttransplant rejection, vascular, as well as biliary complications in both groups, while the secondary endpoints are short-term and intermediate-term living donor morbidity or mortality.
Results
From November 2018 through December 2020, 33 PLTs were operated by the same consultant surgeons in The Leeds Teaching Hospitals with the following distribution: 18 PLT from deceased donors and 15 PLT from living donors. Median recipients’ age was significantly lower in the living donor group than the deceased donor group (1.3 vs. 2.4 years; =0.030). Similarly, median recipient weight was significantly lower in the living donor group than the deceased donor group (7.8 vs. 13.5 kg; =0.007). From indication of transplant prospective, chronic liver failure was the main indication in both groups (73%). The most common indication for PLT was biliary atresia in 13 (39.3%) patients. In terms of donor sex, living donors tended to be females, while deceased donors tended to be males (=0.046). The most common graft type used in both groups was left lateral segment. Warm ischemia time did not show a significant difference between both groups, while median cold ischemia time was significantly longer in the deceased donor group (94 vs. 469 min; ≤0.001). The only significant difference between two groups in terms of vascular complications was a higher rate of portal vein thrombosis in the living donor group (4 vs. 0; =0.033). There was no statistically significant difference between two groups in terms of rates of bile leak or biliary stricture. The rates of rejection were higher in recipients of cadaveric grafts (33.3%) than living donor grafts (13.3%), but the difference was not statistically significant (=0.242). None of the grafts from living or deceased donor source showed either primary nonfunction or delayed graft function. None of the recipients in both either living or deceased grafts required retransplantation. During the follow-up period, all recipients in both groups remained alive. No morbidity or mortality was recorded in the living donors in our series, either during posthepatectomy hospital stay or during outpatient follow-up appointments.
Conclusions
Patient and graft survival rates after deceased and living donor PLT do not vary substantially, and the rates of postoperative complications are similar. To reduce waiting list deaths, deceased and living donor PLT are two solutions that should go hand in hand.