Donor-Recipient Height Mismatch Is Associated With Decreased Survival in Pediatric-to-Adult Liver Transplant Recipients.

Journal Article (Journal Article)

Liver grafts from pediatric donors represent a small fraction of grafts transplanted into adult recipients, and their use in adults requires special consideration of donor size to prevent perioperative complications. In the past, graft weight or volume ratios have been adopted from the living donor liver transplant literature to guide clinicians; however, these metrics are not regularly available to surgeons accepting deceased donor organs. In this study, we evaluated all pediatric-to-adult liver transplants in the United Network for Organ Sharing Standard Transplant Analysis and Research database from 1987 to 2019, stratified by donor age and donor-recipient height mismatch ratio (HMR; defined as donor height/recipient height). On multivariable regression controlling for cold ischemia time, age, and transplantation era, the use of donors from ages 0 to 4 and 5 to 9 had increased risk of graft failure (hazard ratio [HR], 1.81 [P < 0.01] and HR, 1.16 [P < 0.01], respectively) compared with donors aged 15 to 17. On Kaplan-Meier survival analysis, a HMR < 0.8 was associated with inferior graft survival (mean, 11.8 versus 14.6 years; log-rank P < 0.001) and inferior patient survival (mean, 13.5 versus 14.9 years; log-rank P < 0.01) when compared with pairs with similar height (HMR, 0.95-1.05; ie, donors within 5% of recipient height). This study demonstrates that both young donor age and low HMR confer additional risk in adult recipients of pediatric liver grafts.

Full Text

Duke Authors

Cited Authors

  • Kesseli, SJ; Samoylova, ML; Yerxa, J; Moore, CB; Cerullo, M; Gao, Q; Abraham, N; Patel, YA; McElroy, LM; Vikraman, D; Barbas, AS

Published Date

  • February 2021

Published In

Volume / Issue

  • 27 / 3

Start / End Page

  • 425 - 433

PubMed ID

  • 33188659

Electronic International Standard Serial Number (EISSN)

  • 1527-6473

Digital Object Identifier (DOI)

  • 10.1002/lt.25937

Language

  • eng

Conference Location

  • United States