Transplanting whole livers from donors less than 6 kilograms - Is it prudent?

N. Thao T. Nguyen, Theresa R. Harring, Hao Liu, John A. Goss, Christine A. O'Mahony

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared. Methods: The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed. Results: Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7%, 71.4%, 68.4%, and 65.9% at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1%, 78.7%, 77.3%, and 75.4% at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8%, 84.7%, 82.7%, and 80.6% at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4%, 90.7%, 89.6%, and 88.5% at 1, 3, 5, and 10 y. Conclusions: Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival.

Original languageEnglish (US)
Pages (from-to)348-358
Number of pages11
JournalJournal of Surgical Research
Volume177
Issue number2
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Allografts
Tissue Donors
Liver
Living Donors
Survival
Liver Transplantation
Databases
Weights and Measures

Keywords

  • Allograft allocation
  • Cox regression
  • Donor weight
  • Liver transplantation
  • Pediatric
  • Split liver transplantation
  • Survival outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Transplanting whole livers from donors less than 6 kilograms - Is it prudent? / Nguyen, N. Thao T.; Harring, Theresa R.; Liu, Hao; Goss, John A.; O'Mahony, Christine A.

In: Journal of Surgical Research, Vol. 177, No. 2, 01.10.2012, p. 348-358.

Research output: Contribution to journalArticle

Nguyen, N. Thao T. ; Harring, Theresa R. ; Liu, Hao ; Goss, John A. ; O'Mahony, Christine A. / Transplanting whole livers from donors less than 6 kilograms - Is it prudent?. In: Journal of Surgical Research. 2012 ; Vol. 177, No. 2. pp. 348-358.
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abstract = "Introduction: Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared. Methods: The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed. Results: Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7{\%}, 71.4{\%}, 68.4{\%}, and 65.9{\%} at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1{\%}, 78.7{\%}, 77.3{\%}, and 75.4{\%} at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8{\%}, 84.7{\%}, 82.7{\%}, and 80.6{\%} at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4{\%}, 90.7{\%}, 89.6{\%}, and 88.5{\%} at 1, 3, 5, and 10 y. Conclusions: Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival.",
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T1 - Transplanting whole livers from donors less than 6 kilograms - Is it prudent?

AU - Nguyen, N. Thao T.

AU - Harring, Theresa R.

AU - Liu, Hao

AU - Goss, John A.

AU - O'Mahony, Christine A.

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Introduction: Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared. Methods: The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed. Results: Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7%, 71.4%, 68.4%, and 65.9% at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1%, 78.7%, 77.3%, and 75.4% at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8%, 84.7%, 82.7%, and 80.6% at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4%, 90.7%, 89.6%, and 88.5% at 1, 3, 5, and 10 y. Conclusions: Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival.

AB - Introduction: Experience suggests transplanting whole liver allografts (WL) from donors weighing <6 kg portends a worse prognosis. Patient and allograft survivals of infants who underwent transplantation with livers from donors ≥6 kg, <6 kg, or technical variant allografts from deceased donors (TV) and those from living donors (LD) were compared. Methods: The United Network of Organ Sharing database was queried for infant orthotopic liver transplantation (≤2 y). Of 5976 orthotopic liver transplantations, 860 patients received TV from deceased donors, 534 received LD split allografts, 509 patients had WL from donors weighing <6 kg, and 4073 remaining patients had WL from donors weighing ≥6 kg. Kaplan-Meier method and log-rank tests were employed. Results: Patients who received WL from donors weighing <6 kg had survival mean of 13.9 y ± 177 d. Overall patient survivals were 76.7%, 71.4%, 68.4%, and 65.9% at 1, 3, 5, and 10 y. This is significantly worse compared with all other groups, both in patient and allograft survival (P ≤ 0.001). In patients whose donors ≥6 kg, overall patient survivals were 82.1%, 78.7%, 77.3%, and 75.4% at 1, 3, 5, and 10 y. Infants who received TV had patient survival of 87.8%, 84.7%, 82.7%, and 80.6% at 1, 3, 5, and 10 y. Infants who received LD allografts had patient survival of 92.4%, 90.7%, 89.6%, and 88.5% at 1, 3, 5, and 10 y. Conclusions: Smaller weight of the donor influences the infant patient outcome. Patients with allografts from donors weighing <6 kg have a worse prognosis compared with those who received TV and LD allografts and those whose donors weigh ≥6 kg. Patients who receive LD allografts had the best survival.

KW - Allograft allocation

KW - Cox regression

KW - Donor weight

KW - Liver transplantation

KW - Pediatric

KW - Split liver transplantation

KW - Survival outcomes

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