Doctors in a study from Vanderbilt University claim children who undergo liver transplantation face an improved chance of survival when a living donor is involved, as opposed to transplant procedures involving deceased donors.1
A Last-Resort Option
Liver transplants are typically last-resort options for people with end-stage liver disease. It is often considered for people with the following symptoms: jaundice, fluid build-up in the legs or stomach, muscle wasting, easy bruising or bleeding, bloody vomit or stool, difficulty concentrating, or abrupt changes in liver test results that suggest the organ is failing. People considered candidates for liver transplantation are then placed on a waiting list before a suitable liver can be found for them.
While recipients typically return to as normal a life as possible after the surgery, they are still required to take medication every day to prevent potential rejection of the new liver, and will likely need to consult with their physician on a regular basis. Complications of liver transplantation include diabetes, high blood pressure, high cholesterol and occasional infections. But these can also be managed.2
The first pediatric liver transplant was performed some 30 years ago. Since then, living donor liver transplantation, in which a person donates part of his or her liver to a child, has become common practice due to the extreme shortage of donor livers available. Biliary atresia accounts for at least half of all pediatric liver transplants in the United States.3
Comparative Outcomes
In their retrospective study, Mary Austin, MD, in the department of Surgery at Vanderbilt and her fellow researchers wanted to know whether transplant outcomes for children were the same when living donors were used as opposed to deceased ones.
"We hypothesize that living donor liver transplantation leads to improved graft and patient survival compared with deceased donor whole and split organ transplantation in children with end-stage liver disease," wrote Austin and her colleagues in the journal Archives of Surgery.
Austin's team collected data on all pediatric liver transplants registered in a database maintained by the United Network for Organ Sharing, a non-profit, scientific and education organization that oversees the nation’s Organ Procurement and Transplantation Network. The investigators examined information on transplants performed between 1987 and 1994 in the United States. Both whole and split-organ transplant information was reviewed.
They then compared survival rates of both recipients of the new livers, as well as the new livers themselves.
Living Donor Transplants Had Better Outcomes
In the data analyzed, 81% of the transplants were from a cadaver, another 8% of cases involved split livers from a deceased donor, and about one-tenth of the cases included split livers from living donors.
Austin's team found that recipients of living-donor liver transplants survived in 73% of cases, compared to less than two-thirds of the time in transplants involving livers (whole or partial) taken from cadavers. Fifty-seven percent of the transplant failures resulted in retransplantation, and 43% resulted in patient death, the investigators found.
In explaining the reasons for the improved recipient survival in living-donor transplants, Austin and her colleagues stated that "recipients who are less ill, who have shorter cold and warm ischemia times, and those with a decreased need for retransplantation" face better odds after the surgery. Comparatively, those who are more sick, who have longer cold and warm ischemia times—the transition between freezing and thawing of the organ before the transplant—and those who are more likely to face a subsequent transplant face worse chances of survival, they found.
The failure rate, collectively, was about 35%, the researchers reported. In many of those instances, the recipients underwent a subsequent transplant, but 1,329 children of the 8,771 studied later died. However, the team was quick to add that the type of graft used in these transplant procedures had no impact on outcomes.
Those children who'd been diagnosed with hepatitis, tumor or other liver diseases had worse outcomes than those with biliary atresia and metabolic diseases, the investigators stated.
Living-donor liver transplants are risky to the donor, Austin and her colleagues pointed out, but livers can still regenerate, allowing these types of transplants to be performed, especially in cases involving children who do not need a full-sized adult liver. However, the lingering risks to donors include possible infection and bleeding.
Conflicting Results
Austin and her group acknowledged that their findings conflict with those of other studies, but that may be because the earlier research involved fewer numbers of patients, they stated.
"Although living donor liver transplantation poses risk to the donor, it is, as practiced, a valuable technique in pediatric transplantation to help overcome the critical organ shortage," the researchers concluded.
1. Austin MT, Feurer ID, Chari RS, Gorden DL, Wright JK, Pinson CW. Survival after pediatric liver transplantation: why does living donation offer an advantage? Arch Surg 2005 May;140(5):465-70;discussion 470-1.
2. American Liver Foundation. Liver Transplant. Available at: http://www.liverfoundation.org/cgi-bin/dbs/articles.cgi?db=articles&uid=default&ID=1016&view_records=1. Accessed May 19, 2005.
3. Children's Liver Association for Support Services. Liver Transplantation in Children. Available at: http://www.classkids.org/library/childtx.htm. Accessed May 19, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
