- The Washington Times - Monday, May 16, 2005

Children who undergo liver transplants with organs from living donors have better survival rates than those who receive livers from deceased donors, a new study has found.

The report, published in the May issue of the Archives of Surgery, examined data from the Richmond-based United Network for Organ Sharing (UNOS) regarding pediatric liver transplants performed between Oct. 1, 1987, and May 24, 2004.

Researchers discovered a failure rate of nearly 40 percent for transplants involving dead donors, compared with 27 percent in cases of livers coming from living donors.

Of the 8,771 transplants performed during the seven-year period, 81 percent involved surgeries in which a child received a whole liver from a dead adult; 8 percent were cases in which a dead adult’s liver was split between two recipients; and 11 percent were grafts, or organ transplants, from a living adult.

Researchers, led by Dr. Mary T. Austin of the Vanderbilt University Medical Center in Nashville, Tenn., determined that 3,107 of the 8,771 pediatric transplants failed.

The failures included 1,778 cases (57 percent) in which a child required a second donor liver and 1,327 cases (43 percent) in which a child died.

?We determined that … patient survival in the pediatric population is better with living donor liver transplantation, compared with deceased donor whole or split transplant, but not owing to the graft type itself,? the authors wrote.

Researchers also pointed out that the number of children waiting for liver transplants has doubled since 1993, and those who are younger than 5 represent the age group most likely to die while waiting.

According to UNOS, 29 children between the ages of 1 and 5 died last year of end-stage liver disease as they awaited liver transplants. That compared with four in that age group who died waiting for kidney transplants; 14 who died waiting for heart transplants; 15 who died awaiting intestinal transplants; and two who died of diabetic complications while awaiting pancreatic transplants.

The critical shortage of donor organs for young children has forced surgeons to consider living-donor liver transplants as an option.

The procedure holds risks for healthy adults, and the Vanderbilt researchers advise that it be used carefully.

Even so, ?as practiced, it is a valuable technique in pediatric transplantation to help overcome a critical organ shortage,? the authors concluded.

The study was financed, in part, by the Health Resources and Services Administration, an agency of the federal Department of Health and Human Services.

Agency spokesman David Bowman said liver transplants from living donors are a ?controversial topic,? but the federal government does not have an official policy regarding such procedures.

But he said he is certain the government will consider the newly published findings in its consideration of the issue.

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