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Short and Long-Term Outcomes Associated with Technical Variant Liver Grafts in Pediatric Liver Transplantation: In-Situ versus Ex-Vivo

Delman, Aaron M
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104663292502

Abstract Details

2021, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Pediatric patients with end-stage liver disease (ESLD) are subjected to increased waitlist morbidity and mortality due to a lack of appropriately sized donor allografts. To combat waitlist mortality, increased utilization of Technical Variant Grafts (TVGs) has been proposed. However, recent literature suggests recipients of ex-vivo reduced allografts experience worse graft survival and postoperative complications than in-situ split allografts. The goal of this study was to determine if there are significant differences between pediatric patients who receive in-situ split and ex-vivo reduced allografts. Methods: The prospectively maintained pediatric liver transplant database was queried for all TVG recipients between 2015-2020. Baseline patient demographics, clinical characteristics, intra-operative benchmarks, post-operative complications, and survival curves were compared between in-situ and ex-vivo TVG recipients. Results: In 70 consecutive TVG LT’s, 40 (57.1%) received ex-vivo reduced and 30 (42.9%) received in-situ split allografts. Recipients of in-situ split allografts were more likely to be younger (p<0.01), shorter (p=0.04), weigh less (p=0.02), receive a living donation (p<0.01), and a left lateral segment graft (p<0.01) than ex-vivo reduced recipients. In-situ recipients were exposed to less cold ischemia (p<0.01) and warm ischemia (p<0.01) time. Despite this, there was no difference in estimated blood loss (p=0.26), blood transfusions (p=0.32), or postoperative vascular and biliary complications (all p>0.05). Furthermore, with a median follow-up of 1010 days, there was no difference in patient or graft survival between cohorts on Kaplan-Meier analysis (p>0.05), and ex-vivo reduced allografts were not associated with an increased hazard of death or graft failure on multivariable cox-regression (p>0.05). Conclusion: Ex-vivo reduced allografts have similar intra-operative, postoperative, and long-term survival outcomes as in-situ split allograft recipients. To combat the significant waitlist mortality experienced by pediatric patients with ESLD, transplant physicians and policymakers should encourage the practice of ex-vivo reduction despite the perceived risks of increased allograft ischemic time.
Scott Langevin, Ph.D. (Committee Chair)
Shimul Shah, M.D. (Committee Member)
21 p.
Surgery
Pediatric Liver Transplantation; Technical Variant Grafts; End Stage Liver Disease; Waitlist mortality; In-Situ Split; Ex-Vivo Reduced

Recommended Citations

Citations

  • Delman, A. M. (2021). Short and Long-Term Outcomes Associated with Technical Variant Liver Grafts in Pediatric Liver Transplantation: In-Situ versus Ex-Vivo [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104663292502

    APA Style (7th edition)

  • Delman, Aaron. Short and Long-Term Outcomes Associated with Technical Variant Liver Grafts in Pediatric Liver Transplantation: In-Situ versus Ex-Vivo. 2021. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104663292502.

    MLA Style (8th edition)

  • Delman, Aaron. "Short and Long-Term Outcomes Associated with Technical Variant Liver Grafts in Pediatric Liver Transplantation: In-Situ versus Ex-Vivo." Master's thesis, University of Cincinnati, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104663292502

    Chicago Manual of Style (17th edition)

ucin1617104663292502
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