Thursday, November 24 2022

In the United States alone, 500 children will need a liver transplant this year. Although liver tissue can come from living or deceased donors, no study has shown which of these methods leads to better outcomes for children. In a new publication, researchers at Children’s Hospital in Los Angeles have pooled published results from more than 8,000 pediatric patients on four continents. Data shows that children who receive living donor liver tissue for transplantation are much less likely to experience serious complications such as organ rejection.

Thanks to advances in modern medicine and the liver’s unique ability to regenerate, healthy individuals can donate part of their liver to a patient in need. Many countries around the world have switched to performing liver transplants exclusively from living donors, while in the United States, only 8% of liver transplants are from living donors.

But some hospitals, like the Children’s Hospital in Los Angeles, have a growing living donor program. “We do around 25 to 30 liver transplants per year,” says Rohit Kohli, MBBS, MS, head of the gastroenterology division. About a third of those transplants, he says, come from living donors.

We have published large-scale studies showing the benefits of living donor liver transplantation in adults. And we have also seen the benefits in children. But we really wanted to systematically evaluate it, to provide evidence from around the world to back up what we saw. “

Juliet Emamaullee MD, PhD, Research Director, Abdominal Organ Transplant Division, Children’s Hospital Los Angeles

The team began by looking at more than 2,500 studies. From there, they distilled relevant studies, compiling data from 8,000 pediatric patients who had received livers from living or deceased donors. Results one year after the procedure show that children who received live donor liver transplants had an almost double survival rate while the risk of organ rejection was nearly halved.

There are several advantages to using living donor tissue for liver transplants, which can contribute to the striking difference in results. Live donation often shortens the wait time for a patient in need, as they do not need to wait for an appropriately sized deceased organ donor, which can be especially difficult for infants and all- small, which account for more than 50% of pediatric liver transplants. But perhaps the biggest benefit is that patients can be healthier at the time of their surgery.

“When a liver becomes available, the rule of thumb is that it goes to the sickest child,” says Dr. Kohli. “And that makes sense. We don’t want a child to die on the waiting list.” But, unfortunately, this means that children can wait for years to receive a necessary transplant. It also means that they can be very sick by the time an organ becomes available. This could affect a child’s results once he or she receives a new liver.

“These findings are important and relevant for families,” says Dr Emamaullee. “Not all children are in a center that offers a living donor liver transplant. Now we have the data to suggest that children really should be offered this option. Families should be given the opportunity to donate to their children rather than having to wait for an organ donor to come along. “

Meaningful studies like these often come from many people working together: clinicians, scientists and even students. “We had undergraduate researchers, medical students, a resident and collaborators from a large Canadian center who were helping to pool all of this data and analyze it in meaningful ways,” says Dr. Emamaullee.

“As a pediatrician, I want children to have the best possible chance,” says Dr Kohli. “Studies like these inform our care. They show us how to do the best job possible for our children.”


Journal reference:

Barbetta, A., et al. (2021) Pediatric liver transplantation from living donor versus deceased donor: systematic review and meta-analysis. Direct transplantation.


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