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Donor–Recipient Height Mismatch Is Associated With Decreased Survival in Pediatric‐to‐Adult Liver Transplant Recipients
Author(s) -
Kesseli Samuel J.,
Samoylova Mariya L.,
Yerxa John,
Moore Carrie B.,
Cerullo Marcelo,
Gao Qimeng,
Abraham Nader,
Patel Yuval A.,
McElroy Lisa M.,
Vikraman Deepak,
Barbas Andrew S.
Publication year - 2021
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25937
Subject(s) - medicine , hazard ratio , liver transplantation , perioperative , proportional hazards model , transplantation , young adult , surgery , united network for organ sharing , confidence interval
Liver grafts from pediatric donors represent a small fraction of grafts transplanted into adult recipients, and their use in adults requires special consideration of donor size to prevent perioperative complications. In the past, graft weight or volume ratios have been adopted from the living donor liver transplant literature to guide clinicians; however, these metrics are not regularly available to surgeons accepting deceased donor organs. In this study, we evaluated all pediatric‐to‐adult liver transplants in the United Network for Organ Sharing Standard Transplant Analysis and Research database from 1987 to 2019, stratified by donor age and donor–recipient height mismatch ratio (HMR; defined as donor height/recipient height). On multivariable regression controlling for cold ischemia time, age, and transplantation era, the use of donors from ages 0 to 4 and 5 to 9 had increased risk of graft failure (hazard ratio [HR], 1.81 [ P < 0.01] and HR, 1.16 [ P < 0.01], respectively) compared with donors aged 15 to 17. On Kaplan‐Meier survival analysis, a HMR < 0.8 was associated with inferior graft survival (mean, 11.8 versus 14.6 years; log‐rank P < 0.001) and inferior patient survival (mean, 13.5 versus 14.9 years; log‐rank P < 0.01) when compared with pairs with similar height (HMR, 0.95‐1.05; ie, donors within 5% of recipient height). This study demonstrates that both young donor age and low HMR confer additional risk in adult recipients of pediatric liver grafts.