Date Published: April 20, 2017
Publisher: Public Library of Science
Author(s): Rianne van Rijn, Pieter E. R. Hoogland, Frank Lehner, Ernest L. W. van Heurn, Robert J. Porte, Stanislaw Stepkowski.
Liver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD) donors.
All transplantations performed with a liver from a pediatric donor (≤16 years) in the Netherlands between 2002 and 2015 were included. Patient survival, graft survival, and complication rates were compared between DCD and DBD liver transplantation.
In total, 74 liver transplantations with pediatric grafts were performed; twenty (27%) DCD and 54 (73%) DBD. The median donor warm ischemia time (DWIT) was 24 min (range 15–43 min). Patient survival rate at 10 years was 78% for recipients of DCD grafts and 89% for DBD grafts (p = 0.32). Graft survival rate at 10 years was 65% in recipients of DCD versus 76% in DBD grafts (p = 0.20). If donor livers in this study would have been rejected for transplantation when the DWIT ≥30 min (n = 4), the 10-year graft survival rate would have been 81% after DCD transplantation. The rate of non-anastomotic biliary strictures was 5% in DCD and 4% in DBD grafts (p = 1.00). Other complication rates were also similar between both groups.
Transplantation of livers from pediatric DCD donors results in good long-term outcome especially when the DWIT is kept ≤30 min. Patient and graft survival rates are not significantly different between recipients of a pediatric DCD or DBD liver. Moreover, the incidence of non-anastomotic biliary strictures after transplantation of pediatric DCD livers is remarkably low.
There is a growing discrepancy between the extensive number of patients waiting for liver transplantation and the availability of organs . Therefore, alternative organ sources have been explored in an effort to increase organ availability. During the last decade, there has been a growing interest in liver donation after circulatory death (DCD), also known as non-heart-beating donation. Most studies report that patient survival after DCD liver transplantation is equivalent to that of DBD liver transplantation. However, graft survival after DCD liver transplantation is lower and rate of primary non-function (PNF), vascular thrombosis, and non-anastomotic biliary strictures is higher than after DBD liver transplantation [2–5]. Despite the less favorable outcome of livers from adult DCD compared to those from adult DBD, the former is accepted as an important source of allografts. The implementation of DCD programs in adults has substantially increased the total number of available livers and thereby reduced waiting list mortality [1,2,6].
Between 2002 and 2015, a total number of 74 liver transplantations with pediatric grafts were performed with 20 (27%) DCD and 54 (73%) DBD grafts. The median follow-up of functioning grafts was 85 months (43–125 months), 36 months (24–113 months) for the DCD group and 93 months (61–126 months) for the DBD group. The minimum follow-up was 8 months.
This multicenter study with the largest series of pediatric DCD liver transplantation reports good long-term outcome with 78% patient survival and 65% graft survival at 10 years after transplantation. Patient survival, graft survival, and complication rates were similar between recipients of a pediatric DCD or DBD liver. Moreover, the observed rate of biliary complications and NAS after transplantation of DCD liver grafts was relatively low and no differences were noted between pediatric DCD and DBD livers.