A new study observed successful outcomes in children, some of whom had Alagille syndrome (ALGS), after liver grafts from death after cardiac death (DCD) donors.
The study, published in Pediatric Transplantation, compared parameters and outcomes between full liver grafts (FLG) and reduced liver grafts (RLG) from death after brain death (DBD) and DCD donors.
“Contrary to the practice in adults, utilization of DCD grafts in the pediatric population remains rare,” the authors said. “There have been encouraging reports in respect of outcomes of this donor source from single centers including our published early experience. This is the first study to compare outcomes of FLG and RLG from DCD donors in children.”
The research team analyzed their overall experience with DBD and living donor grafts and then compared outcomes between pediatric patients receiving FLG and RLG from DCD donors. In the first analysis, between 2005 and 2018, 356 patients received grafts from DBD donors and 27 received living donor grafts. For the later analysis, 14 patients received grafts from DCD donors during the same period, 9 of whom received FLG and 5 of whom received RLG.
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Over the 13-year study period, there were comparable outcomes between FLG and RLG from DCD and DBD donors. However, the recipients of RLG were generally older and sicker than those receiving FLG, and those receiving FLG waited significantly longer for a graft than RLG recipients. Intraoperative parameters between the two groups were similar.
Post-transplant, RLG recipients had longer hospital stays than those receiving FLG. Three patients in each group reached 5 years post-transplant; the rest died or were re-transplanted. The authors note that there was no significant difference in liver function tests at 5 years post-transplant, which supports the expansion of the graft pool by including DCD donors.
The research team cautions that the small sample size of the study impedes drawing firm conclusions and thus recommends revising current donor selection criteria in the national registries to allow for further analyses of a wider graft donor pool.
Alnagar A, Mirza DF, Muiesan P, et al. Long-term outcomes of pediatric liver transplantation using organ donation after circulatory death: Comparison between full and reduced grafts. Pediatr Transplant. Published online September 10, 2022. doi:10.1111/petr.14385