AUTHOR=Dalzell Christina , Vargas Paola A. , Soltys Kyle , Dipaola Frank , Mazariegos George , Oberholzer Jose , Goldaracena Nicolas 

TITLE=Living Donor Liver Transplantation vs. Split Liver Transplantation Using Left Lateral Segment Grafts in Pediatric Recipients: An Analysis of the UNOS Database

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10437

DOI=10.3389/ti.2022.10437

ISSN=1432-2277

ABSTRACT=Split and LDLT in pediatric patients has the potential to decrease wait-times and waitlist mortality. Using UNOS-STAR data, we compared outcomes of pediatric patients undergoing LDLT and SLT using LLS grafts. Baseline characteristics and post-operative outcomes were compared between groups. Actuarial graft and patient survival were analyzed with Kaplan-Meier curves. Between 2010-2019, 911 pediatric LT were included in the analysis (LD graft group, n=508, split graft group, n=403). LD graft recipients spent more time on the waitlist vs. the split graft group (60 (22-138) days vs. 46 (16-108) days; p=0.007). LD recipients had a lower rate of graft failure, found in 9.8% of patients compared with 14.6% in the split graft group (p=0.02). HAT was the most common graft failure cause, with similar rates. Graft and patient survival at 1-,3-and 5-years was comparable between LDLT and SLT. In subgroup analyses, patients with biliary atresia, those ≤10kg or ≤10years old receiving a LD graft showed improved graft survival. In conclusion, LDLT is associated with a lower rate of graft failure in pediatric patients. The use of LLS regardless of the type of donor is a safe way to facilitate access to transplantation to pediatric patients with acceptable short and long-term outcomes.