Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
A COMPARISON OF PEDIATRIC LIVER TRANSPLANT PATIENTS RECEIVING LIVE DONOR OR CADAVERIC ALLOGRAFTS
Living related liver transplantation now has a history of almost ten years. Although survival of both graft and patients appears good these data are based mainly on historic controls and comparisons between different centers. We reviewed the results of all children (<16 yr.) receiving their first liver transplant at a single center between 1990 and 1997. The recipients of living related liver allografts (LRLT) were compared to those receiving allografts from cadaveric donors (CadLT), and to the sub-group of recipients receiving reduced-size liver transplants (RSCLT) from cadaveric donors. There were 170 primary orthotopic liver transplants in pediatric patients during this period of which 29 were LRLT. Of the 141 CadLT patients 43 received RSCLT. Post-operative care, including immunosuppression, was the same for both groups. The groups receiving cadaveric and living related allografts were different in terms of age at transplant (median 1.45 v 0.86 yr. respectively, p=0.045) and proportion of transplants carried out for patients receiving intensive care (26% v 7% p=0.031). However, when age at RSCLT was compared to LRLT there was no difference (median age 0.85 v 0.86 yr.). Waiting times (median 42 v 85 days p=0.005) and cold ischemia times (324 v 691 min. p<0.001) were significantly shorter in the live donor group verses CadLT. The relative incidence of rejection and sepsis were similar in all groups. Biliary complications were significantly increased in the LRLT group (biliary leak 28% v 8% p=0.006, stricture 31% v 12% p=0.021) and vascular complications had a higher incidence (24% v 13% p=0.20) without a statistical difference when compared to CadLT. These findings show evidence of a learning curve, with most problems clustered early in the living related program. Actuarial survival for CadLT compared with LRLT show no difference for both graft (1 yr. survival 73.6% v 82.6% respectively) and patient (82.9% v 86.1%). A difference is apparent when RSCLT (graft 58.0%, patient 75.4%) is compared to LRLT. In conclusion, living related liver transplantation is now an established technique with survival in our center equivalent to or possibly better than transplantation with cadaveric allografts.
Hepatology© 1998 Lippincott Williams & Wilkins, Inc.