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. 2021 Sep 20;7(10):e767.
doi: 10.1097/TXD.0000000000001219. eCollection 2021 Oct.

Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis

Arianna Barbetta  1 , Chanté Butler  1 , Sarah Barhouma  1 , Rachel Hogen  1 , Brittany Rocque  1 , Cameron Goldbeck  1 , Hannah Schilperoort  2 , Glenda Meeberg  3 , James Shapiro  3 , Yong K Kwon  1 , Rohit Kohli  4   5 , Juliet Emamaullee  1   6
Affiliations

Living Donor Versus Deceased Donor Pediatric Liver Transplantation: A Systematic Review and Meta-analysis

Arianna Barbetta et al. Transplant Direct. .

Abstract

Reduced-size deceased donors and living donor liver transplantation (LDLT) can address the organ shortage for pediatric liver transplant candidates, but concerns regarding technical challenges and the risk of complications using these grafts have been raised. The aim of this study was to compare outcomes for pediatric LDLT and deceased donor liver transplantation (DDLT) via systematic review.

Methods: A systematic literature search was performed to identify studies reporting outcomes of pediatric (<18 y) LDLT and DDLT published between 2005 and 2019. A meta-analysis was conducted to examine peri- and postoperative outcomes using fixed- and random-effects models.

Results: Overall, 2518 abstracts were screened, and 10 studies met criteria for inclusion. In total, 1622 LDLT and 6326 DDLT pediatric patients from 4 continents were examined. LDLT resulted in superior patient survival when compared with DDLT at 1, 3, and 5 y post-LT (1-y hazard ratio: 0.58, 95% confidence interval [CI] 0.47-0.73, P < 0.0001). Similarly, LDLT resulted in superior graft survival at all time points post-LT when compared with DDLT (1-y hazard ratio: 0.56 [95% CI 0.46-0.68], P < 0.0001]. The OR for vascular complications was 0.73 (95% CI 0.39-1.39) and 1.31 (95% CI 0.92-1.86) for biliary complications in LDLT compared with DDLT, whereas LDLT was associated with lower rates of rejection (OR: 0.66 [95% CI 0.45-0.96], P = 0.03).

Conclusions: This meta-analysis demonstrates that LDLT may offer many advantages when compared with DDLT in children and suggests that LDLT should continue to be expanded to optimize outcomes for pediatric LT candidates.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
PRISMA diagram illustrating the results of systematic review process. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
FIGURE 2.
FIGURE 2.
Comparison of overall survival (OS) between LDLT and DDLT recipients at (A) 1, (B) 3, and (C) 5 y post-LT. DDLT, deceased donor liver transplantation; LT, liver transplantation; O-E, observed minus expected numbers of deaths/graft loss.
FIGURE 3.
FIGURE 3.
Patient survival stratified by deceased donor graft type at 1 y post-LT (panels A and B) and 5 y post-LT (panels C and D). LDLT, living donor liver transplantation; LT, liver transplantation; O-E, observed minus expected numbers of deaths/graft loss.
FIGURE 4.
FIGURE 4.
Comparison of graft survival between LDLT and DDLT recipients at (A) 1, (B) 3, (C) 5 y post-LT. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; LT, liver transplantation; O-E, observed minus expected numbers of deaths/graft loss.
FIGURE 5.
FIGURE 5.
Forest plot of preoperative variables: (A) weight at LT, (B) PELD score, and (C) time on waitlist. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; LT, liver transplantation; PELD, Pediatric End-stage Liver Disease.
FIGURE 6.
FIGURE 6.
Forest plots of postoperative complications: (A) biliary complications, (B) vascular complication, and (C) acute cellular rejection. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation.
See this image and copyright information in PMC

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