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Durable Clinical and Immunologic Advantage of Living Donor Liver Transplantation in Children

Przybyszewski, Eric, M., BS1; Verna, Elizabeth, C., MD, MS1; Lobritto, Steven, J., MD1; Martinez, Mercedes, MD1; Vittorio, Jennifer, M., MD1; Fox, Alyson, N., MD1; Samstein, Benjamin, MD2; Kato, Tomoaki, MD1; Griesemer, Adam, D., MD1; Emond, Jean, C., MD1

doi: 10.1097/TP.0000000000002110
Original Clinical Science—Liver

Background Despite high survival in pediatric living donor liver transplantation (LDLT), only 10% of liver transplants in children in the United States are from living donors, reflecting reluctance to embrace this approach. In addition to optimal timing and graft quality, LDLT may offer immunologic benefit because most donors are haploidentical parents. We sought to quantify the benefit of LDLT compared to deceased donor liver transplantation (DDLT) using granular clinical and immunologic outcomes over the long term.

Methods A retrospective cohort of children (age <18 years) surviving 1 year or longer posttransplant was evaluated to determine the impact of donor type on graft survival and immunologic outcomes.

Results Two hundred forty-one children (177 DDLT and 64 LDLT) were assessed. In multivariable analysis, LDLT was associated with a lower rate of acute cellular rejection (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.29-0.98; P = 0.04), a lower rate of chronic rejection (HR, 0.12; 95% CI, 0.03-0.56; P = 0.007), better graft survival on monotherapy immunosuppression at 3 years posttransplant (87.7% vs 46.7%; odds ratio, 7.41; 95% CI, 2.80-19.66; P < 0.001), and a lower rate of graft loss (HR, 0.29; 95% CI, 0.10-0.88; P = 0.03). Graft type was not an independent predictor of posttransplant mortality (LDLT HR, 0.57; 95% CI, 0.16-2.01; P = 0.38). Maternal graft LDLT was associated with a lower rate of acute cellular rejection (HR, 0.13; 95% CI, 0.03-0.64; P = 0.01) and posttransplant lymphoproliferative disorder (HR, 0.04; 95% CI, 0.004-0.44; P = 0.008) compared with paternal grafts.

Conclusions This study demonstrates the potential benefit of LDLT, particularly with maternal grafts, for pediatric liver transplant recipients on multiple clinical parameters over long-term follow-up.

By comparing the outcome following live (LDLT) vs deceased donor liver transplantation in 241 children (age < 118) surviving ≥ 1-year posttransplant, the authors demonstrate the potential benefit of LDLT, particularly with maternal grafts, for pediatric recipients, on multiple immunological-related parameters.

1 Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY.

2 Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY.

Received 10 May 2017. Revision received 28 November 2017.

Accepted 6 December 2017.

The authors declare no funding or conflicts of interest.

E.M.P. participated in the conception of the work, collection, analysis, and interpretation of data, drafting the article, and final editing. E.C.V. participated in the conception of the work, analysis and interpretation of data, and drafting and editing the article. S.J.L. participated in conception of the work and editing the article. M.M. participated in conception of the work and editing the article. J.M.V. participated in conception of the work and editing the article. A.N.F. participated in conception of the work and editing the article. B.S. participated in conception of the work and editing the article. T.K. participated in conception of the work and editing the article. A.D.G. participated in conception of the work and editing the article. J.C.E. participated in conception and design of the work, interpretation of data, drafting and editing the article, and final approval of the version to be published.

Correspondence: Eric M. Przybyszewski, BS, 622W, 168th St, Room 14-105, New York, NY 10032. (emp2165@columbia.edu).

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