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Objective: Our aim was to determine which donor and recipient factors were independently associated with an increased risk of graft failure in recipients <2 years of age following partial or whole liver transplantation.
Design: Data was collected prospectively by the United Network for Organ Sharing. All covariates suggestive as risk factors for graft loss on univariate analyses (p<0.1) were included in a proportional hazards model of graft survival. Survival analyses were used to examine high-risk subsets. Validation performed with Cross-K-group analysis.
Setting: All National Transplantation Centers
Patients: 3,026 deceased donor liver-alone recipients under the age of 2 years who were transplanted in the United States between 1995 and 2010. Donation after cardiac death, living donors, and multi-organ transplants were excluded. 712 split, 551 reduced, and 1,724 whole livers from deceased donors were included.
Interventions: None
Outcome: Graft Survival
Results: When adjusting for confounding risk factors, both partial graft types were noted to have comparable outcomes to whole livers. Split livers had an adjusted hazard ratio (HR) of graft failure of .99(.8-1.3,p=.92), and reduced livers had an adjusted HR of 1.05(.8-1.3,p=.68) compared to whole livers. Other independently significant predictors of graft failure on multivariate analysis included donor variables such as older age(Unit HR1.02,p<.001) and weight<10kg(HR1.6,p<.001), and recipient variables including dialysis(HR1.7,p=.002), ventilator dependence at the time of transplant(HR1.4,p=.005), previous transplant(HR1.9,p<.001), diagnosis of malignancy(HR1.5,p=.02), parenteral nutrition liver disease(HR 1.8,p=.0005), weight<6kg(HR1.5,p<.001), pre-MELD era(HR1.7,p<.001), and Cold-Ischemia>9Hours(HR1.3,p=.03).
Conclusions: As the adjusted risk of partial and split liver grafts appear to be comparable to whole liver grafts in young recipients, policy development aimed at increasing split liver utilization may help to decrease the currently high infant mortality on the liver waitlist.