Safety and risk of using pediatric donor livers in adult liver transplantation

Sukru Emre, Yuji Soejima, Gulum Altaca, Marcelo Facciuto, Thomas M. Fishbein, Patricia A. Sheiner, Myron E. Schwartz, Charles M. Miller

研究成果: ジャーナルへの寄稿記事

32 引用 (Scopus)

抄録

Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age ≥ 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n = 70) or adult donors (ADs; age ≥ 19 years; n = 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n = 56) and less than 0.5 (n = 21) versus 0.5 or greater (n = 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9%) compared with the AD group (3.8%; P = .0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P = .0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P = .0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level ≥ 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40%; P < .06), septicemia (60%), and decreased 1- and 5-year graft survival rates (40% and 20%; P = .08 and .07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0.4 or greater.

元の言語英語
ページ(範囲)41-47
ページ数7
ジャーナルLiver Transplantation
7
発行部数1
DOI
出版物ステータス出版済み - 1 1 2001
外部発表Yes

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Liver Transplantation
Tissue Donors
Pediatrics
Safety
Liver
Weights and Measures
Hepatic Artery
Cold Ischemia
Thrombosis
Cholestasis
Graft Survival
Transplants
Warm Ischemia
Prothrombin Time
Incidence
Tacrolimus
Immunosuppressive Agents
Bilirubin
Sepsis
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology
  • Transplantation

これを引用

Emre, S., Soejima, Y., Altaca, G., Facciuto, M., Fishbein, T. M., Sheiner, P. A., ... Miller, C. M. (2001). Safety and risk of using pediatric donor livers in adult liver transplantation. Liver Transplantation, 7(1), 41-47. https://doi.org/10.1053/jlts.2001.20940

Safety and risk of using pediatric donor livers in adult liver transplantation. / Emre, Sukru; Soejima, Yuji; Altaca, Gulum; Facciuto, Marcelo; Fishbein, Thomas M.; Sheiner, Patricia A.; Schwartz, Myron E.; Miller, Charles M.

:: Liver Transplantation, 巻 7, 番号 1, 01.01.2001, p. 41-47.

研究成果: ジャーナルへの寄稿記事

Emre, S, Soejima, Y, Altaca, G, Facciuto, M, Fishbein, TM, Sheiner, PA, Schwartz, ME & Miller, CM 2001, 'Safety and risk of using pediatric donor livers in adult liver transplantation', Liver Transplantation, 巻. 7, 番号 1, pp. 41-47. https://doi.org/10.1053/jlts.2001.20940
Emre, Sukru ; Soejima, Yuji ; Altaca, Gulum ; Facciuto, Marcelo ; Fishbein, Thomas M. ; Sheiner, Patricia A. ; Schwartz, Myron E. ; Miller, Charles M. / Safety and risk of using pediatric donor livers in adult liver transplantation. :: Liver Transplantation. 2001 ; 巻 7, 番号 1. pp. 41-47.
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abstract = "Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age ≥ 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n = 70) or adult donors (ADs; age ≥ 19 years; n = 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n = 56) and less than 0.5 (n = 21) versus 0.5 or greater (n = 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9{\%}) compared with the AD group (3.8{\%}; P = .0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P = .0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P = .0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level ≥ 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40{\%}; P < .06), septicemia (60{\%}), and decreased 1- and 5-year graft survival rates (40{\%} and 20{\%}; P = .08 and .07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0.4 or greater.",
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AU - Emre, Sukru

AU - Soejima, Yuji

AU - Altaca, Gulum

AU - Facciuto, Marcelo

AU - Fishbein, Thomas M.

AU - Sheiner, Patricia A.

AU - Schwartz, Myron E.

AU - Miller, Charles M.

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N2 - Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age ≥ 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n = 70) or adult donors (ADs; age ≥ 19 years; n = 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n = 56) and less than 0.5 (n = 21) versus 0.5 or greater (n = 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9%) compared with the AD group (3.8%; P = .0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P = .0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P = .0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level ≥ 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40%; P < .06), septicemia (60%), and decreased 1- and 5-year graft survival rates (40% and 20%; P = .08 and .07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0.4 or greater.

AB - Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age ≥ 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n = 70) or adult donors (ADs; age ≥ 19 years; n = 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n = 56) and less than 0.5 (n = 21) versus 0.5 or greater (n = 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9%) compared with the AD group (3.8%; P = .0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P = .0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P = .0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level ≥ 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40%; P < .06), septicemia (60%), and decreased 1- and 5-year graft survival rates (40% and 20%; P = .08 and .07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0.4 or greater.

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