Living‐Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT). We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD...

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Bibliographic Details
Published in:	American journal of transplantation Vol. 7; no. 2; pp. 440 - 447
Main Authors:	Bourdeaux, C., Darwish, A., Jamart, J., Tri, T.T., Janssen, M., Lerut, J., Otte, J.‐B., Sokal, E., De Ville de Goyet, J., Reding, R.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-02-2007 Blackwell
Subjects:	Adolescent Biological and medical sciences Child Child, Preschool Children Female Graft Rejection - immunology Graft Rejection - mortality Graft Rejection - prevention & control Humans Immunosuppressive Agents - therapeutic use Infant Liver Transplantation - adverse effects Liver Transplantation - immunology Liver Transplantation - mortality Living Donors Male Medical sciences Multivariate Analysis outcome pediatric liver transplantation Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Rate Tacrolimus - therapeutic use Treatment Outcome Pediatrics Prognosis Liver Homograft Transplantation Multivariate analysis Homotransplantation living donors Immunological investigation Surgery Graft Complication Evolution Children Child outcome Human Digestive system Living donor Related donor Recipient Treatment Technique pediatric liver transplantation Cadaver Comparative study
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Summary:	Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT). We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD) (n = 135). Demographic, surgical and immunological variables were compared, and respective impact on posttransplant complications was studied using a multivariate analysis. Five‐year patient survival rates were 92% and 85% for groups LD and DD, respectively (p = 0.181), the corresponding graft survival rates being 89% and 77% (p = 0.033). At multivariate analysis: (1) type of donor (DD) was correlated with higher rate of artery thrombosis (p < 0.012); (2) biliary complication rate at 5 years was 29% and 23% for groups LD and DD, respectively (p = 0.451); (3) lower acute rejection incidence could be correlated with type of donor (DD) (p = 0.001), and immunosuppressive therapy (tacrolimus) (p < 0.001). We conclude that (1) according to the multivariate analysis, LT with LD provided similar patient and graft outcome, when compared to DD; (2) a higher rate of artery thrombosis and a lower rate of rejection were observed in group DD; (3) this study comfirms the efficacy of tacrolimus for immunoprophylaxis, whatever the type of organ donor is. In this single center pediatric liver transplant series, multivariate analysis showed similar patient and graft survivals with living‐related or deceased donors, together with a higher rate of hepatic artery thrombosis and a lower rate of acute rejection in the latter group.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1600-6135 1600-6143
DOI:	10.1111/j.1600-6143.2006.01626.x