EARLY GRAFT FUNCTION AFTER PEDIATRIC LIVER TRANSPLANTATION: COMPARISON BETWEEN in situ SPLIT LIVER GRAFTS AND LIVING-RELATED GRAFTS:

22 Purpose: The systematic application of living-related and cadaveric, in situ split liver transplantation has helped to alleviate the severe shortages in pediatric whole organs. While both techniques have been beneficial, LRD in particular, does carry potential risks. We sought to compare the functional outcomes between pediatric grafts procured from cadaveric, brain dead donors using the in situ split technique (SLD) and those procured from living-related donors (LRD). Materials and Methods: Between August 1993 and November 1998, a total of 34 LRD and 39 SLD have been utilized at UCLA for pediatric liver transplantation (LT). A retrospective review of the medical record for these donors and recipients was undertaken. Data was obtained on preoperative variables, operative courses, postoperative outcomes and laboratory testing. Survival was calculated using the Kaplan-Meier method. Unpaired student T-test was used to compare all other data points. Results: The mean age for the recipients was 1.0 +/− 1.5 years (SLD) vs 2.3 +/− 2.8 years (LRD)(p<0.05). Biliary Atresia was the primary cause of liver disease in both groups. LRD grafts consisted of 33 left lateral segments and 1 left lobe. The actuarial 1-, 3-, and 5-year graft survival for LRD was 84.2%, 79.6%, and 79.6%, respectively. Eight (23.5%) of these grafts were lost to hepatic artery thrombosis (3), hepatic vein stenosis (1), primary non-function (1), or patient death (3). Grafts lost within 30 days of LT were eliminated from further functional analysis leaving a total of 31. SLD grafts consisted of 38 left lateral segments and 1 left lobe. Twelve (30.8%) of these grafts were lost to hepatic artery thrombosis (3), portal vein thrombosis (1), hepatic vein stenosis (1), primary nonfunction (3), antibody-mediated acute rejection (1), chronic rejection (1), and patient death (2). The actuarial 1-, 3-, and 5-year survival for SLD grafts was 80.3%. Grafts lost within 30 days of LT were eliminated from further functional analysis leaving a total of 31. Operative variables impacting outcomes in favor of the LRD group, were a significantly shorter graft cold ischemia time (3:02 +/− 1:38 vs. 6:59 +/− 2:13 hours, p<0.05). Total operative time however, significantly favored the SLD group (6:27 +/− 1:49 vs. 5:09 +/− 1:10 hours, p<0.05). LRD grafts performed better during the first postoperative week as demonstrated by significantly lower aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and prothrombin time. However, by the end of the first week, no significant differences were seen in liver function between the two groups. Conclusions: Both LRD and SLD grafts provide excellent sources for pediatric LT. Early graft function as determined by liver function testing is better in the LRD group. Both groups have a comparable and low rate of technical complications and primary non-function. The reasons behind this are shorter ischemic time, elective surgical intervention, and a more stable donor. However, this early advantage does not translate into a long-term improvement in graft outcome. Therefore, we advocate reserving LRD for recipients in which no cadaveric options exist for LT.