Korean J Transplant.  2020 Sep;34(3):178-184. 10.4285/kjt.2020.34.3.178.

Korea-nationwide incidence of pediatric deceased donors and single-institutional status of liver transplantation using pediatric donor liver grafts

• Namgung JM
• Hwang S
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Kim DY
• Kim KM
• Oh SH
• Lee SG

• KMID: 2507162
• DOI: http://doi.org/10.4285/kjt.2020.34.3.178

Abstract

Background
The present study intended to investigate the allocation status of pediatric deceased donor liver allografts. We analyzed the incidence of pediatric deceased donors in the Korean Network for Organ Sharing (KONOS) database and single-institutional status of liver transplantation (LT) using pediatric donors.
Methods
We assessed the nationwide incidence of pediatric donors aged ≤15 years and conducted single-center analysis of LT using pediatric donors.
Results
Between 2010 and 2019, pediatric donors aged ≤15 years accounted for 171 out of 4,395 donors (3.9%) in the KONOS database and 31 out of 640 liver donors (4.8%) in Asan Medical Center (AMC) database. In AMC, 11 (35.5%) and 20 (64.5%) grafts were allocated to pediatric recipients aged ≤15 years and adult recipients aged ≥19 years, respectively. All nine livers from donors aged ≤5 years were implanted in pediatric re-cipients aged ≤5 years. From 21 donors aged ≥9 years, 16 whole liver grafts and four split extended right liver grafts were implanted in 20 adult recipients and two split left lateral section grafts were implanted in two pediatric recipients. Four split liver grafts were implanted in other institutions. The overall patient survival rates at 1, 3, and 5 years were 90.9%, 80.8%, and 80.8%, respectively in pediatric-to-pediatric LT group and 69.6%, 58.4%, and 58.4%, respectively in pediatric-to-adult LT group (P=0.21).
Conclusions
More than half of the pediatric donor livers were allocated to adult patients. Recipient criteria for allocation of liver allografts from pediatric donors need revision for children on pediatric LT waitlist.

Keyword

Donor age; Pediatric donor; Deceased donor liver transplantation; Infant; Split liver transplantation

Figure

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  Fig. 1 Age distribution of deceased organ donors from January 2010 to December 2019 in Korea. (A) Age distribution of all donors in 5-year intervals. (B) Age distribution of pediatric donors aged up to 15 years in 1-year intervals.

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  Fig. 2 Age distribution of deceased liver donors used for liver transplantation from January 2010 to December 2019 at Asan Medical Center. (A) Age distribution of all donors in 5-year intervals. (B) Age distribution of pediatric donors aged up to 15 years in 1-year intervals.

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  Fig. 3 Comparison of graft survival (A) and overall patient survival (B) outcomes according to recipient age.

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  Fig. 4 Comparison of overall patient survival outcomes according to primary deceased donor liver transplantation and retransplantation.

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