Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Mohit Kehar, MD; Rulan S. Parekh, MD; Jennifer Stunguris, RN; Maria De Angelis, NP; Krista Van Roestel, NP; Anand Ghanekar, MD; Mark Cattral, MD; Annie Fecteau, MD; Simon Ling, MD; Binita M. Kamath, MD; Nicola Jones, MD; Yaron Avitzur, MD; David Grant, MD; Vicky Lee Ng, MD

doi:10.1097/TXD.0000000000000865

Transplantation Direct (Mar 2019)

Superior Outcomes and Reduced Wait Times in Pediatric Recipients of Living Donor Liver Transplantation

Mohit Kehar, MD,
Rulan S. Parekh, MD,
Jennifer Stunguris, RN,
Maria De Angelis, NP,
Krista Van Roestel, NP,
Anand Ghanekar, MD,
Mark Cattral, MD,
Annie Fecteau, MD,
Simon Ling, MD,
Binita M. Kamath, MD,
Nicola Jones, MD,
Yaron Avitzur, MD,
David Grant, MD,
Vicky Lee Ng, MD

Affiliations

Mohit Kehar, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Rulan S. Parekh, MD: 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada.
Jennifer Stunguris, RN: 4 Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
Maria De Angelis, NP: 4 Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
Krista Van Roestel, NP: 4 Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
Anand Ghanekar, MD: 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada.
Mark Cattral, MD: 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada.
Annie Fecteau, MD: 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada.
Simon Ling, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Binita M. Kamath, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Nicola Jones, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Yaron Avitzur, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
David Grant, MD: 2 University of Toronto, Faculty of Medicine, Toronto, ON, Canada.
Vicky Lee Ng, MD: 1 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.

DOI: https://doi.org/10.1097/TXD.0000000000000865
Journal volume & issue: Vol. 5, no. 3
p. e430

Abstract

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Background. Living donor liver transplantation (LDLT) is increasingly used to bridge the gap between the current supply and demand imbalance for deceased donor organs to provide lifesaving liver transplantation. Methods. Outcomes of 135 children who underwent LDLT were compared with 158 recipients of deceased donor liver transplantation (DDLT) at the largest pediatric liver transplant program in Canada. Results. Recipients of LDLT were significantly younger than deceased donor recipients (P ≤ 0.001), less likely to require dialysis pretransplant (P < 0.002) and had shorter wait time duration when the primary indication was cholestatic liver disease (P = 0.003). The LDLT donors were either related genetically or emotionally (79%), or unrelated (21%) to the pediatric recipients. One-, 5-, and 10-year patient survival rates were significantly higher in LDLT (97%, 94%, and 94%) compared with DDLT (92%, 87%, and 80%; log-rank P = 0.02) recipients, as were graft survival rates (96%, 93%, and 93% for LDLT versus 89%, 81.4%, and 70%, respectively, for DDLT; log-rank P = 0.001). Medical and surgical complications were not statistically different between groups. Graft failure was higher in recipients of DDLT (odds ratio, 2.60; 95% confidence interval, 1.02, 6.58) than in the LDLT group after adjustment for clinical characteristics and propensity score. Conclusions. Living donor liver transplantation provides superior outcomes for children and is an excellent and effective strategy to increase the chances of receiving a liver transplant.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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