MS, University of Cincinnati, 2021, 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 spli (open full item for complete abstract)

Committee: Scott Langevin Ph.D. (Committee Chair); Shimul Shah M.D. (Committee Member) Subjects: Surgery