Impact of graft type on outcome in pediatric liver transplantation

A report from Studies of Pediatric Liver Transplantation (SPLIT)

Ivan R. Diamond, Annie Fecteau, J. Michael Millis, Julian E. Losanoff, Vicky Ng, Ravinder Anand, Changhong Song, S. Dunn, J. Menendez, L. Flynn, M. Jonas, L. Krawczuk, M. Christoff, R. Kane, E. Phillips, L. Ferrer, T. Heffron, J. DePaolo, T. Pillen, L. Davis & 140 others J. Bucuvalas, F. Ryckman, A. Hawkins, G. Arya, M. Narkewicz, R. Sokol, F. Karrer, C. Mark, K. Orban-Eller, E. Rand, K. Anderer, G. Mazariegos, N. Chien, L. Seward, P. Atkinson, G. Telega, S. Lerrett, J. Roden, N. Mittal, L. Cutright, E. Alonso, J. Lokar, S. Kelly, K. Neighbors, W. Andrews, J. Daniel, V. Fioravanti, A. Tendick, D. Desai, S. Jarvis, A. Fecteau, V. Ng, M. De Angelis, A. Benidir, J. Tector, J. Lim, J. Molleston, J. Pearson, K. Schwarz, P. Colombani, M. Alford, M. Felix, R. Jurao, J. Eason, J. Eshun, S. Powell, D. Freese, J. Weckwerth, J. Greseth, L. Young, R. Fisher, M. Akyeampong, S. Emre, B. Shneider, N. Kerkar, S. Cuellar, S. Lobritto, L. Smith, P. Harren, K. Maseda, L. Book, M. O'Gorman, C. Kawai, L. Bruschke, J. Kraus, F. Alvarez, S. Martin, C. Viau, H. Soriano, K. Falkenstein, R. Shepherd, J. Lowell, M. Nadler, S. So, W. Berquest, M. Castillo, A. Bula, S. Karpen, J. Mayo, J. Goss, D. Fishman, V. McLin, B. Carter, C. O'Mahony, T. Aloia, D. Garner, S. McDiarmid, S. Fiest, S. Gilmour, B. Dodd, N. Kneteman, J. Lavine, A. Khanna, R. Clawson, P. Rosenthal, D. Filipowski, J. Millis, P. Boone, R. González-Peralta, A. Hemming, M. Hodik, S. McCracken, A. Tzakis, T. Kato, D. Weppler, L. Cooper, M. Gonzalez, A. Santiago, J. Lopez, J. Magee, V. Shieck, A. Humar, B. Durand, L. Studenski, A. Langnas, D. Antonson, J. Botha, W. Grant, D. Sudan, D. Andersen, B. Fleckten, K. Seipel, Jeffrey Fair, S. Lichtman, K. Andreoni, J. Prinzhorn, V. Buchholz, P. Abt, T. Shisler, C. MacK, G. Halff, S. Wallace, S. Horslen, M. Young, M. Kalayoglu, A. D'Alessandro, N. Erickson, R. Judo, S. Knechtle, E. Spaith

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

OBJECTIVE: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients. METHODS: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients. RESULTS: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients. CONCLUSIONS: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)301-310
Number of pages10
JournalAnnals of Surgery
Volume246
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

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Liver Transplantation
Pediatrics
Transplants
Tissue Donors
Liver
Morbidity
Waiting Lists
Mortality
Organ Transplantation
Portal Vein
Registries
Thrombosis
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of graft type on outcome in pediatric liver transplantation : A report from Studies of Pediatric Liver Transplantation (SPLIT). / Diamond, Ivan R.; Fecteau, Annie; Millis, J. Michael; Losanoff, Julian E.; Ng, Vicky; Anand, Ravinder; Song, Changhong; Dunn, S.; Menendez, J.; Flynn, L.; Jonas, M.; Krawczuk, L.; Christoff, M.; Kane, R.; Phillips, E.; Ferrer, L.; Heffron, T.; DePaolo, J.; Pillen, T.; Davis, L.; Bucuvalas, J.; Ryckman, F.; Hawkins, A.; Arya, G.; Narkewicz, M.; Sokol, R.; Karrer, F.; Mark, C.; Orban-Eller, K.; Rand, E.; Anderer, K.; Mazariegos, G.; Chien, N.; Seward, L.; Atkinson, P.; Telega, G.; Lerrett, S.; Roden, J.; Mittal, N.; Cutright, L.; Alonso, E.; Lokar, J.; Kelly, S.; Neighbors, K.; Andrews, W.; Daniel, J.; Fioravanti, V.; Tendick, A.; Desai, D.; Jarvis, S.; Fecteau, A.; Ng, V.; De Angelis, M.; Benidir, A.; Tector, J.; Lim, J.; Molleston, J.; Pearson, J.; Schwarz, K.; Colombani, P.; Alford, M.; Felix, M.; Jurao, R.; Eason, J.; Eshun, J.; Powell, S.; Freese, D.; Weckwerth, J.; Greseth, J.; Young, L.; Fisher, R.; Akyeampong, M.; Emre, S.; Shneider, B.; Kerkar, N.; Cuellar, S.; Lobritto, S.; Smith, L.; Harren, P.; Maseda, K.; Book, L.; O'Gorman, M.; Kawai, C.; Bruschke, L.; Kraus, J.; Alvarez, F.; Martin, S.; Viau, C.; Soriano, H.; Falkenstein, K.; Shepherd, R.; Lowell, J.; Nadler, M.; So, S.; Berquest, W.; Castillo, M.; Bula, A.; Karpen, S.; Mayo, J.; Goss, J.; Fishman, D.; McLin, V.; Carter, B.; O'Mahony, C.; Aloia, T.; Garner, D.; McDiarmid, S.; Fiest, S.; Gilmour, S.; Dodd, B.; Kneteman, N.; Lavine, J.; Khanna, A.; Clawson, R.; Rosenthal, P.; Filipowski, D.; Millis, J.; Boone, P.; González-Peralta, R.; Hemming, A.; Hodik, M.; McCracken, S.; Tzakis, A.; Kato, T.; Weppler, D.; Cooper, L.; Gonzalez, M.; Santiago, A.; Lopez, J.; Magee, J.; Shieck, V.; Humar, A.; Durand, B.; Studenski, L.; Langnas, A.; Antonson, D.; Botha, J.; Grant, W.; Sudan, D.; Andersen, D.; Fleckten, B.; Seipel, K.; Fair, Jeffrey; Lichtman, S.; Andreoni, K.; Prinzhorn, J.; Buchholz, V.; Abt, P.; Shisler, T.; MacK, C.; Halff, G.; Wallace, S.; Horslen, S.; Young, M.; Kalayoglu, M.; D'Alessandro, A.; Erickson, N.; Judo, R.; Knechtle, S.; Spaith, E.

In: Annals of Surgery, Vol. 246, No. 2, 08.2007, p. 301-310.

Research output: Contribution to journalArticle

Diamond, IR, Fecteau, A, Millis, JM, Losanoff, JE, Ng, V, Anand, R, Song, C, Dunn, S, Menendez, J, Flynn, L, Jonas, M, Krawczuk, L, Christoff, M, Kane, R, Phillips, E, Ferrer, L, Heffron, T, DePaolo, J, Pillen, T, Davis, L, Bucuvalas, J, Ryckman, F, Hawkins, A, Arya, G, Narkewicz, M, Sokol, R, Karrer, F, Mark, C, Orban-Eller, K, Rand, E, Anderer, K, Mazariegos, G, Chien, N, Seward, L, Atkinson, P, Telega, G, Lerrett, S, Roden, J, Mittal, N, Cutright, L, Alonso, E, Lokar, J, Kelly, S, Neighbors, K, Andrews, W, Daniel, J, Fioravanti, V, Tendick, A, Desai, D, Jarvis, S, Fecteau, A, Ng, V, De Angelis, M, Benidir, A, Tector, J, Lim, J, Molleston, J, Pearson, J, Schwarz, K, Colombani, P, Alford, M, Felix, M, Jurao, R, Eason, J, Eshun, J, Powell, S, Freese, D, Weckwerth, J, Greseth, J, Young, L, Fisher, R, Akyeampong, M, Emre, S, Shneider, B, Kerkar, N, Cuellar, S, Lobritto, S, Smith, L, Harren, P, Maseda, K, Book, L, O'Gorman, M, Kawai, C, Bruschke, L, Kraus, J, Alvarez, F, Martin, S, Viau, C, Soriano, H, Falkenstein, K, Shepherd, R, Lowell, J, Nadler, M, So, S, Berquest, W, Castillo, M, Bula, A, Karpen, S, Mayo, J, Goss, J, Fishman, D, McLin, V, Carter, B, O'Mahony, C, Aloia, T, Garner, D, McDiarmid, S, Fiest, S, Gilmour, S, Dodd, B, Kneteman, N, Lavine, J, Khanna, A, Clawson, R, Rosenthal, P, Filipowski, D, Millis, J, Boone, P, González-Peralta, R, Hemming, A, Hodik, M, McCracken, S, Tzakis, A, Kato, T, Weppler, D, Cooper, L, Gonzalez, M, Santiago, A, Lopez, J, Magee, J, Shieck, V, Humar, A, Durand, B, Studenski, L, Langnas, A, Antonson, D, Botha, J, Grant, W, Sudan, D, Andersen, D, Fleckten, B, Seipel, K, Fair, J, Lichtman, S, Andreoni, K, Prinzhorn, J, Buchholz, V, Abt, P, Shisler, T, MacK, C, Halff, G, Wallace, S, Horslen, S, Young, M, Kalayoglu, M, D'Alessandro, A, Erickson, N, Judo, R, Knechtle, S & Spaith, E 2007, 'Impact of graft type on outcome in pediatric liver transplantation: A report from Studies of Pediatric Liver Transplantation (SPLIT)', Annals of Surgery, vol. 246, no. 2, pp. 301-310. https://doi.org/10.1097/SLA.0b013e3180caa415
Diamond, Ivan R. ; Fecteau, Annie ; Millis, J. Michael ; Losanoff, Julian E. ; Ng, Vicky ; Anand, Ravinder ; Song, Changhong ; Dunn, S. ; Menendez, J. ; Flynn, L. ; Jonas, M. ; Krawczuk, L. ; Christoff, M. ; Kane, R. ; Phillips, E. ; Ferrer, L. ; Heffron, T. ; DePaolo, J. ; Pillen, T. ; Davis, L. ; Bucuvalas, J. ; Ryckman, F. ; Hawkins, A. ; Arya, G. ; Narkewicz, M. ; Sokol, R. ; Karrer, F. ; Mark, C. ; Orban-Eller, K. ; Rand, E. ; Anderer, K. ; Mazariegos, G. ; Chien, N. ; Seward, L. ; Atkinson, P. ; Telega, G. ; Lerrett, S. ; Roden, J. ; Mittal, N. ; Cutright, L. ; Alonso, E. ; Lokar, J. ; Kelly, S. ; Neighbors, K. ; Andrews, W. ; Daniel, J. ; Fioravanti, V. ; Tendick, A. ; Desai, D. ; Jarvis, S. ; Fecteau, A. ; Ng, V. ; De Angelis, M. ; Benidir, A. ; Tector, J. ; Lim, J. ; Molleston, J. ; Pearson, J. ; Schwarz, K. ; Colombani, P. ; Alford, M. ; Felix, M. ; Jurao, R. ; Eason, J. ; Eshun, J. ; Powell, S. ; Freese, D. ; Weckwerth, J. ; Greseth, J. ; Young, L. ; Fisher, R. ; Akyeampong, M. ; Emre, S. ; Shneider, B. ; Kerkar, N. ; Cuellar, S. ; Lobritto, S. ; Smith, L. ; Harren, P. ; Maseda, K. ; Book, L. ; O'Gorman, M. ; Kawai, C. ; Bruschke, L. ; Kraus, J. ; Alvarez, F. ; Martin, S. ; Viau, C. ; Soriano, H. ; Falkenstein, K. ; Shepherd, R. ; Lowell, J. ; Nadler, M. ; So, S. ; Berquest, W. ; Castillo, M. ; Bula, A. ; Karpen, S. ; Mayo, J. ; Goss, J. ; Fishman, D. ; McLin, V. ; Carter, B. ; O'Mahony, C. ; Aloia, T. ; Garner, D. ; McDiarmid, S. ; Fiest, S. ; Gilmour, S. ; Dodd, B. ; Kneteman, N. ; Lavine, J. ; Khanna, A. ; Clawson, R. ; Rosenthal, P. ; Filipowski, D. ; Millis, J. ; Boone, P. ; González-Peralta, R. ; Hemming, A. ; Hodik, M. ; McCracken, S. ; Tzakis, A. ; Kato, T. ; Weppler, D. ; Cooper, L. ; Gonzalez, M. ; Santiago, A. ; Lopez, J. ; Magee, J. ; Shieck, V. ; Humar, A. ; Durand, B. ; Studenski, L. ; Langnas, A. ; Antonson, D. ; Botha, J. ; Grant, W. ; Sudan, D. ; Andersen, D. ; Fleckten, B. ; Seipel, K. ; Fair, Jeffrey ; Lichtman, S. ; Andreoni, K. ; Prinzhorn, J. ; Buchholz, V. ; Abt, P. ; Shisler, T. ; MacK, C. ; Halff, G. ; Wallace, S. ; Horslen, S. ; Young, M. ; Kalayoglu, M. ; D'Alessandro, A. ; Erickson, N. ; Judo, R. ; Knechtle, S. ; Spaith, E. / Impact of graft type on outcome in pediatric liver transplantation : A report from Studies of Pediatric Liver Transplantation (SPLIT). In: Annals of Surgery. 2007 ; Vol. 246, No. 2. pp. 301-310.
@article{1809ebe343314c78965979217fa62458,
title = "Impact of graft type on outcome in pediatric liver transplantation: A report from Studies of Pediatric Liver Transplantation (SPLIT)",
abstract = "OBJECTIVE: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients. METHODS: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients. RESULTS: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1{\%} whole, 66.7{\%} split, 65.5{\%} reduced, 51.9{\%} live-donor). Biliary complications (30 day: 7.5{\%} whole, 18.8{\%} split, 16{\%} reduced, 17.5{\%} live-donor) and portal vein thrombosis (30 day: 3.6{\%} whole, 8{\%} split, 8{\%} reduced, 7.5{\%} live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients. CONCLUSIONS: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.",
author = "Diamond, {Ivan R.} and Annie Fecteau and Millis, {J. Michael} and Losanoff, {Julian E.} and Vicky Ng and Ravinder Anand and Changhong Song and S. Dunn and J. Menendez and L. Flynn and M. Jonas and L. Krawczuk and M. Christoff and R. Kane and E. Phillips and L. Ferrer and T. Heffron and J. DePaolo and T. Pillen and L. Davis and J. Bucuvalas and F. Ryckman and A. Hawkins and G. Arya and M. Narkewicz and R. Sokol and F. Karrer and C. Mark and K. Orban-Eller and E. Rand and K. Anderer and G. Mazariegos and N. Chien and L. Seward and P. Atkinson and G. Telega and S. Lerrett and J. Roden and N. Mittal and L. Cutright and E. Alonso and J. Lokar and S. Kelly and K. Neighbors and W. Andrews and J. Daniel and V. Fioravanti and A. Tendick and D. Desai and S. Jarvis and A. Fecteau and V. Ng and {De Angelis}, M. and A. Benidir and J. Tector and J. Lim and J. Molleston and J. Pearson and K. Schwarz and P. Colombani and M. Alford and M. Felix and R. Jurao and J. Eason and J. Eshun and S. Powell and D. Freese and J. Weckwerth and J. Greseth and L. Young and R. Fisher and M. Akyeampong and S. Emre and B. Shneider and N. Kerkar and S. Cuellar and S. Lobritto and L. Smith and P. Harren and K. Maseda and L. Book and M. O'Gorman and C. Kawai and L. Bruschke and J. Kraus and F. Alvarez and S. Martin and C. Viau and H. Soriano and K. Falkenstein and R. Shepherd and J. Lowell and M. Nadler and S. So and W. Berquest and M. Castillo and A. Bula and S. Karpen and J. Mayo and J. Goss and D. Fishman and V. McLin and B. Carter and C. O'Mahony and T. Aloia and D. Garner and S. McDiarmid and S. Fiest and S. Gilmour and B. Dodd and N. Kneteman and J. Lavine and A. Khanna and R. Clawson and P. Rosenthal and D. Filipowski and J. Millis and P. Boone and R. Gonz{\'a}lez-Peralta and A. Hemming and M. Hodik and S. McCracken and A. Tzakis and T. Kato and D. Weppler and L. Cooper and M. Gonzalez and A. Santiago and J. Lopez and J. Magee and V. Shieck and A. Humar and B. Durand and L. Studenski and A. Langnas and D. Antonson and J. Botha and W. Grant and D. Sudan and D. Andersen and B. Fleckten and K. Seipel and Jeffrey Fair and S. Lichtman and K. Andreoni and J. Prinzhorn and V. Buchholz and P. Abt and T. Shisler and C. MacK and G. Halff and S. Wallace and S. Horslen and M. Young and M. Kalayoglu and A. D'Alessandro and N. Erickson and R. Judo and S. Knechtle and E. Spaith",
year = "2007",
month = "8",
doi = "10.1097/SLA.0b013e3180caa415",
language = "English (US)",
volume = "246",
pages = "301--310",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Impact of graft type on outcome in pediatric liver transplantation

T2 - A report from Studies of Pediatric Liver Transplantation (SPLIT)

AU - Diamond, Ivan R.

AU - Fecteau, Annie

AU - Millis, J. Michael

AU - Losanoff, Julian E.

AU - Ng, Vicky

AU - Anand, Ravinder

AU - Song, Changhong

AU - Dunn, S.

AU - Menendez, J.

AU - Flynn, L.

AU - Jonas, M.

AU - Krawczuk, L.

AU - Christoff, M.

AU - Kane, R.

AU - Phillips, E.

AU - Ferrer, L.

AU - Heffron, T.

AU - DePaolo, J.

AU - Pillen, T.

AU - Davis, L.

AU - Bucuvalas, J.

AU - Ryckman, F.

AU - Hawkins, A.

AU - Arya, G.

AU - Narkewicz, M.

AU - Sokol, R.

AU - Karrer, F.

AU - Mark, C.

AU - Orban-Eller, K.

AU - Rand, E.

AU - Anderer, K.

AU - Mazariegos, G.

AU - Chien, N.

AU - Seward, L.

AU - Atkinson, P.

AU - Telega, G.

AU - Lerrett, S.

AU - Roden, J.

AU - Mittal, N.

AU - Cutright, L.

AU - Alonso, E.

AU - Lokar, J.

AU - Kelly, S.

AU - Neighbors, K.

AU - Andrews, W.

AU - Daniel, J.

AU - Fioravanti, V.

AU - Tendick, A.

AU - Desai, D.

AU - Jarvis, S.

AU - Fecteau, A.

AU - Ng, V.

AU - De Angelis, M.

AU - Benidir, A.

AU - Tector, J.

AU - Lim, J.

AU - Molleston, J.

AU - Pearson, J.

AU - Schwarz, K.

AU - Colombani, P.

AU - Alford, M.

AU - Felix, M.

AU - Jurao, R.

AU - Eason, J.

AU - Eshun, J.

AU - Powell, S.

AU - Freese, D.

AU - Weckwerth, J.

AU - Greseth, J.

AU - Young, L.

AU - Fisher, R.

AU - Akyeampong, M.

AU - Emre, S.

AU - Shneider, B.

AU - Kerkar, N.

AU - Cuellar, S.

AU - Lobritto, S.

AU - Smith, L.

AU - Harren, P.

AU - Maseda, K.

AU - Book, L.

AU - O'Gorman, M.

AU - Kawai, C.

AU - Bruschke, L.

AU - Kraus, J.

AU - Alvarez, F.

AU - Martin, S.

AU - Viau, C.

AU - Soriano, H.

AU - Falkenstein, K.

AU - Shepherd, R.

AU - Lowell, J.

AU - Nadler, M.

AU - So, S.

AU - Berquest, W.

AU - Castillo, M.

AU - Bula, A.

AU - Karpen, S.

AU - Mayo, J.

AU - Goss, J.

AU - Fishman, D.

AU - McLin, V.

AU - Carter, B.

AU - O'Mahony, C.

AU - Aloia, T.

AU - Garner, D.

AU - McDiarmid, S.

AU - Fiest, S.

AU - Gilmour, S.

AU - Dodd, B.

AU - Kneteman, N.

AU - Lavine, J.

AU - Khanna, A.

AU - Clawson, R.

AU - Rosenthal, P.

AU - Filipowski, D.

AU - Millis, J.

AU - Boone, P.

AU - González-Peralta, R.

AU - Hemming, A.

AU - Hodik, M.

AU - McCracken, S.

AU - Tzakis, A.

AU - Kato, T.

AU - Weppler, D.

AU - Cooper, L.

AU - Gonzalez, M.

AU - Santiago, A.

AU - Lopez, J.

AU - Magee, J.

AU - Shieck, V.

AU - Humar, A.

AU - Durand, B.

AU - Studenski, L.

AU - Langnas, A.

AU - Antonson, D.

AU - Botha, J.

AU - Grant, W.

AU - Sudan, D.

AU - Andersen, D.

AU - Fleckten, B.

AU - Seipel, K.

AU - Fair, Jeffrey

AU - Lichtman, S.

AU - Andreoni, K.

AU - Prinzhorn, J.

AU - Buchholz, V.

AU - Abt, P.

AU - Shisler, T.

AU - MacK, C.

AU - Halff, G.

AU - Wallace, S.

AU - Horslen, S.

AU - Young, M.

AU - Kalayoglu, M.

AU - D'Alessandro, A.

AU - Erickson, N.

AU - Judo, R.

AU - Knechtle, S.

AU - Spaith, E.

PY - 2007/8

Y1 - 2007/8

N2 - OBJECTIVE: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients. METHODS: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients. RESULTS: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients. CONCLUSIONS: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.

AB - OBJECTIVE: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients. METHODS: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients. RESULTS: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients. CONCLUSIONS: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.

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UR - http://www.scopus.com/inward/citedby.url?scp=34547565747&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3180caa415

DO - 10.1097/SLA.0b013e3180caa415

M3 - Article

VL - 246

SP - 301

EP - 310

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -