CORRECTED-Living-donor liver transplantation has long-term advantages in children

Last Updated: 2018-02-07

(Modifies headline and first paragraph, to clarify study findings, and adds new paragraph 6.)

By Will Boggs MD

NEW YORK (Reuters Health) - Living-donor liver transplantation has durable clinical and immunological benefits in pediatric transplant patients, according to a retrospective study.

"Our findings provide strong support for a more confident recommendation of living donor as the best option for children needing liver transplantation," said Dr. Eric M. Przybyszewski from Columbia University Medical Center, in New York City.

"Our data demonstrating that grafts from living donors have lower long-term immunologic risks compared to grafts from deceased donors provides support for this recommendation," he told Reuters Health by email.

Living-donor liver transplantation (LDLT) has been used successfully for pediatric recipients for nearly 30 years, yet long-term benefits have yet to be shown.

Dr. Przybyszewski and colleagues examined outcomes of 241 consecutive pediatric liver-transplant recipients, including 64 LDLT (26.6%) and 177 deceased donor liver transplant (DDLT, 73.4%) recipients in their retrospective cohort study.

The transplants were done between January 1998 and October 2015. Mean follow-up was 11.6 years for recipients of living donor grafts and 6.5 years for recipients of deceased donor grafts.

Most living-donor grafts (90.6%) were from a parental donor (42 maternal donors and 33 paternal donors), the researchers report in Transplantation, online January 23.

Acute cellular rejection (ACR) was significantly more common among DDLT recipients (39.0%) than among LDLT recipients (20.3%). After adjustment for other factors, LDLT was associated with a 47% lower risk of posttransplant ACR (P=0.04), whereas African American or black race and autoimmune liver disease more than doubled the risk of post-transplant ACR.

The rate of chronic rejection was also much higher for DDLT recipients (13.0%) than for LDLT recipients (4.7%), though this difference only became statistically significant in Kaplan-Meier analysis. Other factors contributing to chronic rejection included African American or black race, biliary complication, and ACR events.

LDLT recipients were far more likely to achieve graft survival and monotherapy immunosuppression at three years post-transplant (87.7% vs. 46.7%; P<0.001).

In multivariable analyses, LDLT was independently associated with a 71% lower risk of graft loss (P=0.03) but was not associated with differences in post-transplant mortality.

Compared with paternal grafts, maternal grafts were associated with significantly lower risks of ACR and post-transplant lymphoproliferative disorder (PTLD) but not with differences in graft failure or mortality.

"Our study suggests that living donation may offer long-term immunologic benefits for pediatric liver-transplant recipients compared to deceased donation," Dr. Przybyszewski said. "Evaluation and selection of living donors was not specifically evaluated in this study but is certainly an important and emerging area of investigation."

He added, "I would like to highlight the contributions made by organ donors and their families. Decisions surrounding donation are never easy and often take place during emotionally complex times. Their courage is inspiring and life-saving. I am personally grateful to have witnessed many incredible journeys."

SOURCE: http://bit.ly/2nIJ9o3

Transplantation 2018.