Parts Can Equal the Whole Liver

Partial liver grafts donated to babies have similar rates of success as whole transplants

(RxWiki News) That call about your child's liver transplant can lift one of many burdens. And whether it's a whole or partial liver, the success rates are about the same.

Partial liver transplantation donations for infants from deceased donors can work just as successfully as whole liver donations, a new study shows.

This study's findings show that partial liver graft donations could reduce the number of illnesses and deaths among kids who are high risk transplant candidates.

"Talk to a specialist about liver transplant risks."

The mortality rate for infants on the liver wait list is twice that of adults, according to researchers. Whole livers from deceased donors are also limited, especially with having to find the correct size for each recipient.

A study, led by Ryan Cauley, MD, from the Department of Surgery at Boston Children's Hospital, looked at the risk of graft failure and mortality in children who receive partial livers from deceased donors. Researchers also aimed to see if the risks have changed over time.

The liver filters harmful chemicals from the blood and creates substances to help digest food.

The study include 2,679 infants under 2 years of age who were listed in the United Network for Organ Sharing (UNOS) database between 1995 and 2010 as first-time liver recipients from deceased donors.

More than half the patients received a whole donated liver and the rest received a portion of a liver. With the partial grafts, donated livers were either shared among different recipients (called split grafts) or discarded (called reduced grafts).

Patients who had re-transplants, organs from living donors or organs from donors who died from heart attack were excluded.

The researchers tracked why the liver grafts were or were not successfully transplanted. They also categorized the infants into one of three groups based on when they received the graft – 1995-2000, 2001-2005 and 2006-2010.

The deceased donors who gave partial liver grafts were significantly older than donors who gave whole livers. More of the partial grafts compared to the whole liver grafts were given to infants who were less than a year old.

The researchers said that the recipients of the partial grafts were "sicker" than recipients of whole grafts. Sicker was defined as needing a ventilator before the transplant or having a higher score on the pediatric end-stage liver disease test.

The number of partial grafts that survived compared to the number of whole grafts that survived was similar between 2001-2005 and 2006-2010, researchers found.

"It's gratifying to see that this new study supports the assumption that split liver transplants can be as successful as whole liver transplantation, because children on the waiting list stand a better chance of getting an organ matched for their size. It is encouraging to see that, despite the age of the donors being older than whole liver donors, the success rates remained about the same for the different time periods studied," said Laurie Reece, Executive Director of the Texas Transplantation Society.

Partial liver grafts failed 40 percent of the time during the 1995-2000 period, and 41 percent of the time in the 2006-2010 period.

In total, 698 graft failures and 345 deaths occurred among the participants. Ninety-two percent of these occurred in the first four years after the transplant.

Livers from donors who were over 40 years old had a significantly worse graft survival rate compared to livers from younger donors.

Further, patients who were in the ICU on a ventilator were also at a significantly higher chance of having a failed transplant.

Donors and recipients who weighed less than 10 and 6 kilograms respectively were also more likely to have a failed transplant.

"We believe that split liver transplants have comparable outcomes to transplants of size matched whole grafts in all young pediatric recipients, making them a safe alternative to size matched whole organs," the researchers wrote in their report.

"By expanding the use of partial liver grafts in young recipients it may be possible to reduce the unacceptably high morbidity and mortality of high-risk pediatric transplant candidates."

"Until we either have enough organ donors or the technology to use artificial organs, I think split liver donations will continue to help get kids transplanted quicker," said Reece, who was not involved in the study.

The authors noted they could not compare graft types since some of the data was missing. In addition, they could not detect differences in the risk of dying since there were fewer deaths in the study compared to the number of graft failures.

The study was published online May 21 in the journal Liver Transplantation. No conflicts of interest were reported.

Review Date: 
June 15, 2013