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Pediatric Surgery: Promising Alternatives to Whole-Liver Transplants

There’s heartening news for children with serious liver disease: A new Johns Hopkins study of patient and graft survival trends for pediatric liver transplant recipients between 2002 and 2015 shows that outcomes for alternatives to whole-liver transplantation have improved significantly.

“Our study indicates that while there were initially worse outcomes when a whole liver from a deceased donor was given to two recipients, known as a split-liver transplant, outcomes are now similar to the classic liver transplant, when a whole liver is given to one recipient. Additionally, outcomes when a living donor gives a portion of his or her liver [which can subsequently regenerate] may actually be superior to a whole-liver transplant,” says Douglas Mogul, medical director of pediatric liver transplantation and lead author of the study, which appeared in The Journal of Pediatrics.

Currently, donor livers from deceased people are allocated to patients based on the Pediatric End-Stage Liver Disease score or Model for End-Stage Liver Disease system, which provide a score for potential recipients based on how urgently they need a liver transplant within the next three months. Those with high scores can be subject to long-term physical and mental impairments, hospitalizations, and increased costs until they are sick enough to qualify for a transplant. One in 10 children on the waitlist dies each year.

Alternatives to taking whole livers from deceased donors can potentially increase organ supply, shorten waitlist times, and reduce pretransplant complications and deaths, according to Mogul.

While there has been an emerging consensus that adult recipients of split-liver transplantation do just as well as recipients of whole-liver transplantation for several years, outcomes among children have been less clear, Mogul says.

To better understand recent outcomes for pediatric liver transplants by transplant type, Mogul and the research team looked at data for liver-only pediatric transplant recipients from the Scientific Registry of Transplant Recipients, a data system that includes information on all donors, wait-listed candidates and transplant recipients in the United States.

“A recent report tells us that nearly half of all children who died while on the waitlist didn’t receive a single offer for an organ. Our findings, which show that overall patient and graft survivals have improved and that outcomes for alternatives to whole-liver transplantation are comparable, will hopefully influence policy for organ allocation—such as greater use of split-liver transplantation,” says Mogul.