Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation

A major drawback in pediatric liver transplantation is the severe shortage of appropriately sized livers. Between 25 and 30 percent of children waiting for liver transplants die before an appropriate donor organ can be found. When liver transplantation possible, it offers the hope of long-term survival. A report is presented of 141 transplantations performed on 117 children using 54 reduced-size grafts. Ten children were under one year of age; 63 were between l and 3 years old; 21 were between 3 and 6; and, 23 were between 6 and 14 years old. The most common indication for transplant was biliary atresia, a congenital absence of one or more of the biliary structures, which affected 86 patients. Reduced-size livers were used in both urgent and elective cases. There were 83 full-size livers and 54 reduced-size livers transplanted; 4 were considered other technical variants. The one-year survival rate for the entire group was 77 percent; for the full-size liver recipients it was 82 percent, and for the reduced-size liver recipients it was 68 percent. Graft loss occurred with 26 (31 percent) of the full-size livers, and 24 (44 percent) of the reduced-size livers. Of the 74 children who had functioning livers six months after transplant, 67 percent had completely normal liver function tests, and 14 percent had only slightly abnormal liver tests. Use of this technique has reduced the mortality of children on the waiting list to 14 percent. It is concluded that the technique of reduced-size liver transplantation is safe and reliable and is recommended for treatment in urgent and elective cases. (Consumer Summary produced by Reliance Medical Information, Inc.)