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