AI Article Synopsis
- Pediatric living donor liver transplantation (LDLT) is rarely conducted in the U.S., with this study examining how the volume of LDLT at transplant centers affects waiting list and post-transplant outcomes for patients under 18 years old.* -
- 44 out of 88 transplant centers performed at least one LDLT from 2009 to 2019, and higher LDLT center volumes correlated with lower dropout rates from waiting lists, while deceased donor partial liver transplant (DDPLT) volumes were linked to reduced recipient death and graft loss.* -
- The findings suggest that high-volume pediatric LDLT centers can enhance waiting list survival, and comprehensive expertise in various liver transplant methods is crucial for improving overall patient outcomes.*
Article Abstract
Background: Pediatric living donor liver transplantation (LDLT) remains infrequently performed in the United States and localized to a few centers. This study aimed to compare pediatric waiting list and posttransplant outcomes by LDLT center volume.
Methods: The Scientific Registry of Transplant Recipients/Organ Procurement and Transplantation Network database was retrospectively reviewed for all pediatric (age <18 y) liver transplant candidates listed between January 1, 2009, and December 31, 2019. The average annual number of LDLT, deceased donor partial liver transplant (DDPLT), and overall (ie, LDLT + DDPLT + whole liver transplants) pediatric liver transplants performed by each transplant center during the study period was calculated.
Results: Of 88 transplant centers, only 44 (50%) performed at least 1 pediatric LDLT during the study period. LDLT, DDPLT, and overall transplant center volume were all positively correlated. LDLT center volume was protective against waiting list dropout after adjusting for confounding variables (adjusted hazard ratio, 0.92; 95% confidence interval, 0.86-0.97; P = 0.004), whereas DDPLT and overall center volume were not ( P > 0.05); however, DDPLT center volume was significantly protective against both recipient death and graft loss, whereas overall volume was only protective against graft loss and LDLT volume was not protective for either.
Conclusions: High-volume pediatric LDLT center can improve waiting list survival, whereas DDPLT and overall volume are associated with posttransplant survival. Expertise in all types of pediatric liver transplant options is important to optimize outcomes.
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| http://dx.doi.org/10.1097/TP.0000000000004173 | DOI Listing |
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