Transplantation 1993 Apr;55(4):835-40

Improved results of living-related liver transplantation with routin
application in a pediatric program

Emond JC, Heffron TG, Kortz EO, Gonzalez-Vallina R, Contis JC, Black DD,
Whitington PF

Abstract
Living related liver transplantation (LRT) was introduced as a response to the
shortage of donor organs that has existed for small children. Results were
promising in the initial experience, with a one-year patient survival of 80% and
a graft survival of 75%. Since the completion of the protocol, LRT has been
considered routinely in the management of children in our center. We present
here our experience with 45 consecutive transplants in which LRT accounts for
40% of grafts with an overall patient survival of 90%. Between 4/91 and 4/92, 45
OLT were performed in 41 children. Median age was 2.7 years (3 months to 13
years) and weight was 10.4 kg (3.5-60 kg). Thirty-five were primary grafts, 10
were retransplants. One patient received 2 grafts in the orthotopic auxiliary
position. Cholestatic disorders including biliary atresia accounted for 60%,
metabolic diseases for 15%. Grafts were obtained from cadaver donors in 27/45
(60%) cases; reduction was required in 12/27 (44%). LRT was performed in 18
cases. Fifty-two percent of recipients of cadaver grafts were UNOS status 4,
while 16% of LRT recipients met these criteria. Actual patient survival for
cadaver grafts is 21/24 (88%) and graft survival is 20/27 (74%). Patient
survival in 18 LRT was 94%. Two grafts were lost to arterial thrombosis for a
graft survival of 83%. All donors have been discharged and are well. One
patient, a teenager with fulminant hepatitis, was successfully transplanted with
a left lobe from his father. This experience demonstrates the programmatic
flexibility accorded by use of LRT. Since 40% of grafts were LRT, more livers
were available for urgent use for patients who did not have a donor available,
as reflected in the 73% incidence of cadaver recipients on status 3 or 4.
Therefore, patients are more likely to receive a transplant at the optimal time.
We are now prepared to offer LRT for fulminant hepatic failure since the benefit
of graft availability appears to outweigh concerns about coerced donation. The
successful treatment of a teenaged patient may herald extension of LRT to
adults. We conclude that the use of LRT should be expanded