UPMC Pediatric Liver Transplant Experts Study Impact of Technical Variant Grafts on Wait List Deaths, Outcomes

While significant advancements have been made in the field of pediatric liver transplantation over the last four decades, challenges remain, including a consensus in the pediatric liver transplant community on optimal graft choice. Pediatric liver transplant wait list mortality remains a grave concern – between 5-10% of children on the liver transplant waiting list in the US die or are removed from the list for becoming too sick before their life saving transplant. It is imperative to optimize graft choice and timing for every child in need of a liver transplant.

To address these challenges, a team of physician-scientists from UPMC, including George V. Mazariegos, MD, chief, Pediatric Transplantation, recently conducted a retrospective analysis on the impact of technical variant grafts (TVGs) on wait list mortality and pediatric liver transplant outcomes. Their study, “Center use of technical variant grafts varies widely and impacts pediatric liver transplant waitlist and recipient outcomes in the United States,” was published in Liver Transplantation.

The team analyzed data from the Organ Procurement and Transplantation Network (OPTN) on first-time pediatric liver transplant or liver-kidney transplant candidates listed between 2004 and 2020. A total of 9,934 children aged 18 years or younger were listed at 64 centers in the United States (all centers performed more than 10 liver transplants within the study period). Of the study population, 4,687 were transplanted with whole grafts, while 3,155 were transplanted with TVGs (either with split/partial grafts from deceased donors or living donor grafts).

Among their findings, the team determined that TVG usage at individual pediatric liver transplant centers was associated with reduced waiting times and lower wait list mortality. Additionally, the use of living donor partial grafts was associated with significantly increased survival, while deceased donor TVG grafts had similar outcomes to whole grafts.

Read the full study.