PEDIATRIC LIVER TRANSPLANT
Shorter Waits; Longer Lives
How does the largest volume livingdonor pediatric liver transplant center in the country optimize patient outcomes?
Too many children die while waiting for a liver transplant. In the United States, about one in 10 infants and one in 20 older children die while on the liver transplant waiting list— and 40 % of children who make it to transplant spend over a year on the waitlist( 1). As the largest volume center for livingdonor pediatric liver transplants( LDLTs) in the U. S., the multidisciplinary team at Children’ s Hospital Colorado is positioned to ensure all children have access to lifesaving liver transplants.
Since the very first liver transplant in the world was performed at the University of Colorado in 1963, deceased donor liver transplants( DDLTs) have represented the most common donor type for treating a range of conditions, including biliary atresia, acute liver failure and end-stage liver disease. But as the available pool of suitable pediatric deceased donors has decreased over time, LDLTs have emerged as an excellent option for meeting the demand for size-matched grafts in children( 2).
2.0 MONTHS
Median transplant wait time, less than half the national median for high-volume programs
Children’ s Colorado liver transplant patient and graft survival data for transplants during the calendar year
2021
95 %
Pediatric liver transplants
Non-directed living donors
Children’ s Colorado
National
21
Directed living donors
5
2021
7
56 424
Volume: 20
Deceased donors
Based on Organ Procurement and Transplantation Network data as of
July 2022
20
TOTAL
501
TOTAL
IMPORTANCE OF A HIGH-VOLUME CENTER
While the impact of LDLT center volume on the waiting list and posttransplant outcomes has been demonstrated in the adult population, little was known about how LDLTs affect the pediatric population.
In a retrospective review of 6,744 children listed for liver transplantation and 5,101 pediatric liver transplants performed in the U. S. between 2009 and 2019, Children’ s Colorado researchers, including Dor Yoeli, MD, and Megan Adams, MD, found that increasing access and listing at multiple centers, including high-volume centers with expertise in LDLTs and DDLTs, could optimize waiting lists and post-transplant outcomes. In another study, researchers found that only 41 % of candidates listed at a low-volume center reached liver transplantation, whereas 85 % of those listed at a high-volume center were transplanted( 3).
“ While these findings were expected based on what we’ ve seen in the adult population, they provide further evidence of the benefits of offering LDLTs,” Dr. Adams says.“ While we still depend on DDLTs, living donors are making up the difference and helping meet the demand for pediatric liver transplants.”
EMERGENCE OF LDLTS IN COLORADO
Children’ s Colorado offers a range of technical variant grafts, including whole liver, split-liver and segmental, and the emergence of LDLTs has significantly reduced time on the waiting list, down to just two months, while increasing the number of transplants performed each year.
8 | CHILDREN’ S HOSPITAL COLORADO