Fifteen-Year Trends in Pediatric Liver Transplants: Split, Whole Deceased, and Living Donor Grafts

Objective: To evaluate changes in patient and graft survival for pediatric liver transplant recipients since 2002, and to determine if these outcomes vary by graft type (whole liver transplant, split liver transplant [SLT], and living donor liver transplant [LDLT]). Study design: We evaluated patient and graft survival among pediatric liver-only transplant recipients the PELD/MELD system was implemented using the Scientific Registry of Transplant Recipients. Results: From 2002-2009 to 2010-2015, survival for SLT at 30 days improved (94% vs 98%; P <.001), and at 1 year improved for SLT (89% to 95%; P <.001) and LDLT (93% to 98%; P =.002). There was no change in survival for whole liver transplant at either 30 days (98% in both; P =.7) or 1 year (94% vs 95%; P =.2). The risk of early death with SLT was 2.14-fold higher in 2002-2009 (adjusted hazard ratio [aHR] vs whole liver transplant, _1.47 2.14 _3.12 ), but this risk disappeared in 2010-2015 (aHR, _0.65 1.13 _1.96 ), representing a significant improvement (P =.04). Risk of late death after SLT was similar in both time periods (aHR 2002-2009, _0.87 1.14 _1.48 ; aHR 2010-2015, _0.56 0.88 _1.37 ). LDLT had similar risk of early death (aHR 2002-2009, _0.49 1.03 _2.14 ; aHR 2010-2015, _0.26 0.74 _2.10 ) and late death (aHR 2002-2009, _0.52 0.83 _1.32 ; aHR 2010-2015, _0.17 0.44 _1.11 ). Graft loss was similar for SLT (aHR, _0.93 1.09 _1.28 ) and was actually lower for LDLT (aHR, _0.53 0.71 _0.95 ). Conclusions: In recent years, outcomes after the use of technical variant grafts are comparable with whole grafts, and may be superior for LDLT. Greater use of technical variant grafts might provide an opportunity to increase organ supply without compromising post-transplant outcomes.