PEDIATRICS

A. Delsemme-therrien¹, F. Alvarez², M. Lallier¹, M. Beaunoyer^3
1Paediatric Surgery, Sainte-Justine University Hospital Centre, montreal/QC/CANADA, ²Paediatric Hepato-gastroenterology, Sainte-Justine University Hospital Centre, Montreal/QC/CANADA, ³Paediatric Surgery, Sainte-Justine University Hospital Centre, Montreal/CANADA

Body: Introduction: The current trend in pediatric liver transplantation is the selection of young cadaveric donors (<40 years). However, this trend is not entirely reflected at our center where the age limit is around 50 years. There are several reasons for this: number of fewer donors, a mean donor age of 49 years in our OPO (Organ Procurement Organization), and also fewer pediatric donors when compared to the United States (8,6 %). However, despite this difference in practice, the overall survival of patients and grafts from our center is comparable to data provided by the SPLIT (Study of Pediatric Liver Transplantation), with a mortality of <1% on waiting list. In order to assess the impact of cadaveric donor age on pediatric liver transplantation, we reviewed our experience looking at graft loss and patient mortality. Methods: All cases of liver transplants performed at our center between 1988 and 2009, and whose data on the donor were available, were retrospectively reviewed. Data was collected from medical records and databases of our OPO. Recipients (n=174) were divided into two groups according to donor age: <40 years (n=130) and ≥40 years (n=44). The primary outcomes of the study – graft loss and mortality of recipients – were compared between the two groups using the chi-square test and the survival of grafts and recipients was illustrated using Kaplan-Meier curves. Only the first transplant of each patient was considered. Results: Our two groups of recipients were similar in terms of gender, mean age, and severity of diagnosis at transplant. Yet, in the group receiving grafts from older donors, 45,5% of patients were hospitalized at transplant (p=0,048). In the recipients of donors aged <40 years (n=130), we observed an overall mortality rate of 22,3% (n=29) compared to a rate of 36,4% (n=16) in the group of donors aged ³ 40 years, with a p=0.066. Yet the survival of both groups at one year seem comparable (82% vs. 75%) but differ at 5 years (79% VS 63%). Regarding the overall loss of the graft, we obtained the respective rates of 27,7% (n=36) and 45,5% (n=20), statistically significant with a p=0.029. Liver survival at 1 year (77% vs. 64%) and 5 year (73% Vs 53%) for younger and older donor respectively was different. Conclusion: Our results suggest that there is a strong trend towards a significant increase in overall mortality in the long term in pediatric patients receiving a liver from a donor aged 40 years or more during a first transplant (p=0.066). Moreover, our results show a statistically significant increase in graft loss in recipients of a liver from a donor aged 40 years or more (p=0.029).

Disclosure: All authors have declared no conflicts of interest.