Advances and Answers in Pediatric Health
What started as an altruistic gesture to give a child a second chance at life , has turned into a movement . In 2017 , an anonymous non-directed donor offered a portion of their liver to the University of Colorado Hospital , which they offered first to pediatric patients on the waiting list at Children ’ s Colorado . Under the leadership of Elizabeth Pomfret , MD , and Michael Wachs , MD , of Children ’ s Colorado , the pediatric LDLT program continued to grow with great outcomes for both recipients and donors . The total number of transplants for all donor types grew to 20 lifesaving transplants performed in 2021 — the most since the program ’ s inception in 1990 . For the last several years , Children ’ s Colorado has performed more than half of liver transplants from living donors — the majority of those from anonymous non-directed donors .
Traditionally , Pediatric End-Stage Liver Disease scores are used for prioritizing children on the waiting list for liver transplants , meaning their disease must progress and make them really sick before they can get a liver transplant . But LDLT allows recipients to get a liver transplant before they get to that stage of disease severity — leading to a quicker timeline to transplant , faster recoveries and better posttransplant outcomes .
“ Offering LDLTs allows recipients to bypass the uncertainty of being on a waiting list and receive a transplant before they get too sick ,” says Dor Yoeli , MD , “ and the introduction of non-directed living donors expands the benefits to children on waiting lists who might not have a suitable directed live donor with a healthy liver and matching blood type .”
Interest in becoming a donor has also gone viral . Just a few years ago , a 4-year-old girl in Colorado received a liver transplant from an altruistic stranger after her parents posted on Facebook seeking a donor . Her story of receiving a donation from a complete stranger went viral , leading to five new non-directed liver donors .
BENEFITS OF LDLTS
LDLT is a win-win-win for patients , doctors and donors . It offers familiarity and a clearer view of the donor ’ s liver quality and more control over the surgery timeline . For donors , donating to a child means less liver volume needs to be removed — as children only need a small part of the liver for it to regenerate to its full size . Waiting times at Children ’ s Colorado are less than half the national average . Also , recipients of LDLTs are 42 % less likely to die and 44 % less likely to experience graft loss at one-year post-transplant ( 4 ).
EXPANDING ACCESS
As Children ’ s Colorado works to meet the demand for pediatric liver transplants in Colorado and regionally , Drs . Yoeli and Adams expect the program to expand nationally where patients experience more competition for liver transplants or don ’ t have access to LDLT-capable centers .
“ There ’ s also an added value of multiple listing ,” says Dr . Adams , “ where patients are evaluated in Colorado and return home to wait for the first-available transplant — increasing their chances of receiving a transplant sooner .” Multiple listing means being listed at a patient ’ s local primary liver center , but also listing at Children ’ s Colorado to explore the possibility of living donation .
While other barriers exist , including far travel distances for treatment or a lack of awareness of the possibility to have a livedonor liver transplant , Children ’ s Colorado and its multidisciplinary team of experts are well positioned to advance the care for some of the most complex cases in the U . S .
“ The benefits of LDLTs at high-volume centers are clear ,” says Dr . Yoeli , “ but it ’ s also worth exploring policies or programs that can help expand access to this lifesaving option and being thoughtful about addressing existing health disparities , rather than propagating them .” •
1 . Perito ER , Roll G , Dodge JL , Rhee S , Roberts JP . Split Liver Transplantation and Pediatric Waitlist Mortality in the United States : Potential for Improvement . Transplantation . 2019 Mar ; 103 ( 3 ): 552 – 557 . doi : 10.1097 / TP . 0000000000002249 . PMID : 29684000 ; PMCID : PMC6773658 .
2 . Yoeli D , Goss M , Galván NTN , Desai MS , Miloh TA , Rana A . Trends in pediatric liver transplant donors and deceased donor circumstance of death in the United States , 2002-2015 . Pediatr Transplant . 2018 May ; 22 ( 3 ): e13156 . doi : 10.1111 / petr . 13156 . Epub 2018 Jan 30 . PMID : 29380468 .
3 . Rana A , Pallister Z , Halazun K , Cotton R , Guiteau J , Nalty CC , O ’ Mahony CA , Goss JA . Pediatric Liver Transplant Center Volume and the Likelihood of Transplantation . Pediatrics . 2015 Jul ; 136 ( 1 ): e99-e107 . doi : 10.1542 / peds . 2014- 3016 . Epub 2015 Jun 15 . PMID : 26077479 .
4 . Barbetta A , Butler C , Barhouma S , Hogen R , Rocque B , Goldbeck C , Schilperoort H , Meeberg G , Shapiro J , Kwon YK , Kohli R , Emamaullee J . Living Donor Versus Deceased Donor Pediatric Liver Transplantation : A Systematic Review and Meta-analysis . Transplant Direct . 2021 Sep 20 ; 7 ( 10 ): e767 . doi : 10.1097 / TXD . 0000000000001219 . PMID : 34557584 ; PMCID : PMC8454909 .
MEGAN ADAMS , MD
Associate Fellowship Director , Children ’ s Hospital Colorado
Assistant professor , Department of Surgery , Division of Transplant Surgery , University of Colorado School of Medicine
DOR YOELI , MD
General surgery resident , Department of Surgery , Children ’ s Hospital Colorado , University of Colorado School of Medicine
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