The changing epidemiology of liver donors in pediatric liver transplantation

L.M. Nieuwenhuis, M. van Londen, M.J.M. Werner, R.H.J. de Kleine, M.T. de Boer, F.A.J.A. Bodewes, R.J. Porte, V.E.D.M. de Meijer

Thursday 15 march 2018

15:25 - 15:30h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 2: Clinical

Background

Because pediatric deceased donors are scarce, adult livers are often used in pediatric liver transplantation. The graft size mismatch of adult livers necessitates split or reduction, or use of living donors. Donor graft quality is important for using partial grafts, and highly predictive for liver transplant outcome.

Aim

Evaluation of accepted liver donor characteristics for pediatric recipients over time.

Methods

A single-center study of all liver donors for pediatric recipients (

Results

Between 1982-2017, 495 pediatric liver transplantations were analyzed, divided in the era’s 1979-1999 (182), 2000-2009 (151), and 2010-2017 (162). From 1979-1999, 68 (38%) liver grafts originated from Dutch centers (NL), 61 (34%) from German centers (GE), and 17 (9%) from Belgian centers (BE). Mean±SD donor age was 16±14 years, 80 (44%) were female, and mean BMI was 19±4 kg/m². All grafts were from donation after brain death (DBD) donors. Main causes of death were traumatic brain injury (60%) and cerebrovascular disease (30%). The majority of liver grafts were full-size (89%). Mean recipient age was 6±5 years. In contrast, from 2010-2017, 98 (61%) liver grafts originated from NL, 34 (21%) from GE, and 16 (10%) from BE (P<0.001). Mean donor age was 37±19 years (P<0.001), 103 (64%) were female (P<0.001), and mean BMI was 23±4 kg/m² (P<0.001). 114 (70%) of grafts were from DBD donors, whereas 9 (6%) grafts were from DCD donors, and 39 (24%) grafts from living donors (P<0.001). Main causes of death were cerebrovascular disease (48%) and traumatic brain injury (14%); (P<0.001). Mean recipient age was 6±5 years (P=0.75). There were 93 (58%) full-size and 68 (42%) partial liver transplantations, (P<0.001).

Conclusion

Over the past decennia, the epidemiology of liver donors for pediatric recipients has significantly shifted towards increased use of living donors, use of donors from NL, use of older donors, and a change towards more cerebrovascular disease as main cause of death, but less traumatic brain injury. These data provide insight into the changing characteristics of liver donors for pediatric recipients, and should be taken into account when performing outcomes-based research.