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Frequency of whole‐organ in lieu of split‐liver transplantation over the last decade: Children experienced increased wait time and death
Author(s) -
Valentino Pamela L.,
Emre Sukru,
Geliang Gan,
Li Luhang,
Deng Yanhong,
Mulligan David,
RodriguezDavalos Manuel I
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15481
Subject(s) - medicine , liver transplantation , organ transplantation , transplantation , intensive care medicine , pediatrics , surgery
Organ shortage is a barrier to liver transplantation ( LT ). Split LT ( SLT ) increases organ utilization, saving 2 recipients. A simulation of Organ Procurement and Transplantation Network/United Network for Organ Sharing data (2007‐2017) was performed to identify whole‐organ LT grafts ( WLT ) that met the criteria for being splittable to 2 recipients. Waitlist consequences presented. Deceased donor ( DD ) livers transplanted as whole organs were evaluated for suitability to split. Of these DD organs, we identified the adolescent and adult recipients of WLT who were suitable for SLT . Pediatric candidates suitable to share the SLT were ascertained from DD match‐run lists, and 1342 splittable DD organs were identified; 438 WLT recipients met the criteria for accepting a SLT . Review of the 438 DD match‐run lists identified 420 children next on the list suitable for SLT . Three hundred thirty‐three children (79%) underwent LT , but had longer wait‐times compared to 591 actual pediatric SLT recipients (median 147 days vs 44 days, P < 0.001). Thirty‐three of 420 children died on waitlist after a mean 206 days (standard deviation 317). Sharing organs suitable for splitting increases the number of LT , saving more lives. With careful patient selection, SLT will not be a disadvantage to the adult recipients. With a children‐first allocation scheme, SLT will naturally increase the number of allografts because adult organs are too large for small children.