Korean J Transplant.  2020 Dec;34(4):249-256. 10.4285/kjt.20.0036.

Whole liver deceased donor liver transplantation for pediatric recipients: single-center experience for 20 years

• Namgoong JM
• Hwang S
• Kim DY
• Ha TY
• Song GW
• Jung DH
• Park GC
• Kim KM
• Oh SH

• KMID: 2510263
• DOI: http://doi.org/10.4285/kjt.20.0036

Abstract

Background
We investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center.
Methods
The study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years.
Results
During the study period, there were 98 cases of pediatric DDLT, and 34 pa- tients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson dis-ease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the re-cipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively.
Conclusions
The results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good perfor-mance. Considering the reciprocal trades of liver organs among pediatric and adult donors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

Keyword

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

Figure

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  Fig. 1 Illustration of the modified piggyback technique to make a large cavocaval anastomosis. After clamping of the suprahepatic and retrohepatic inferior vena cava (IVC), the orifices of the right, middle, and left hepatic vein trunks are opened altogether to make a large single orifice. A 4–5-cm-long longitudinal incision is made at the ventral surface of the retrohepatic IVC to enlarge the anastomotic vein orifice. A 4-cm-long longitudinal incision is also made at the dorsal surface of the graft IVC. These triangular-shaped orifices at the recipient and graft IVCs are well matched, thus being tolerant to extrinsic compression.

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  Fig. 2 Illustration of the side-to-side unification technique used for portal vein (PV) reconstruction. A deep longitudinal incision is made at the 6 o’clock direction of the graft PV and the 12 o’clock direction of the recipient PV. Running sutures are used to unify these two PVs. This technique creates an enlarged conduit from the superior mesenteric vein-splenic vein confluence to the hilar PV confluence.

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  Fig. 3 Scatter plots showing the age distribution of recipients and donors. Distribution of all the 34 recipients (A) and younger subgroups with recipient age ≤6 years (B). A dotted line denotes correlation.

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  Fig. 4 A scatter plot showing body weight distribution of recipients and donors. The red dotted line denotes correlation. Two green dotted lines indicate the range of donor body weight matching according to the Korean Network for Organ Sharing (KONOS) regulations. All cases except for one were located within the eligible range of recipient-donor weight matching.

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  Fig. 5 A scatter plot showing the distribution of the recipient’s body and whole liver graft’s weight. The red dotted line denotes correlation.

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  Fig. 6 Scatter plot showing the distribution of the recipient’s body and graft-recipient weight ratio (GRWR). The red dotted line denotes correlation. The green dotted line indicates the theoretical upper limit of GRWR according to the recipient’s body weight.

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  Fig. 7 Kaplan-Meier analysis of the overall patient survival outcomes following whole liver transplantation in pediatric recipients.

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