Bootcongres

Background and aims: Liver transplantation with grafts from donors after cardiac death (DCD) is increasingly accepted as a valuable extension of the donor pool, but DCD liver grafts from pediatric donors are only rarely transplanted and their outcome is relatively unknown. The objective of this retrospective cohort study was to assess the effect of warm ischemic injury on pediatric grafts. The outcome of liver transplantation with grafts from pediatric DCD was compared to that with grafts from pediatric donors after brain death (DBD). Methods: The results of all liver transplantation from 2002 until 2011 with Dutch pediatric grafts aged 16 years or younger were reviewed. Data was obtained from the Dutch National Organ Transplantation Registry, with additional centre data. Graft survival, patient survival, rate of primary non-function (PNF), and complications were compared between DCD and DBD grafts with log rank test, logistic regression analysis and Cox- regression analysis respectively. Results: In total, 82 liver transplantations with pediatric grafts were performed; twelve (15%) DCD and 70 (85%) DBD. Death censored graft survival was lower in DCD than in DBD recipients (58% versus 81% at 5 years, p = 0.040), which was caused by a higher rate of PNF in DCD grafts (odds ratio 22.33, p = 0.010). Death censored graft survival of grafts functioning after 3 months was not significantly different (78% in DCD versus 85% DBD recipients at 5 years, p = 0.647). Recipient survival and rate of complications were not significantly different. Conclusion: The results suggest that warm ischemic injury may lead to poor graft survival in pediatric grafts. However recipient survival is not affected and long term survival of functioning grafts is equivalent. The conditions for liver transplantation with pediatric DCD grafts have yet to be investigated in larger study populations in order to identify grafts with acceptable graft survival allowing maximal expansion of the donor pool.