Hepatitis disease - Livers From Children Are Going To Adults, University Of Pittsburgh Review Of National

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Livers From Children Are Going To Adults, University Of Pittsburgh Review Of National

Alan

2005-09-24, 2:09 pm

Using More Split Livers Could Save Hundreds More Children And Adults

CHICAGO, May 17 -- Nearly two-thirds of all livers donated by children since
1991 were transplanted into adults instead of their peers on the national liver
transplant waiting list, despite an increase in the number of pediatric donors,
an analysis of nearly 30,000 liver transplants performed in the United States
shows.

With fewer of these livers available for children, surgeons have been forced to
look at alternative options, such as those involving transplanting a piece of a
liver. These types of procedures have increased dramatically, with adults -- as
either living or cadaveric donors -- the primary source of these liver segments.
But such efforts have had an impact neither on the waiting list death rate nor
on the total number of transplants in children each year, reported university of
Pittsburgh researchers today at the American Society of Transplantation (AST)
18th Annual Scientific Meeting.

"How can we assure that children are better served? One might propose a
preferential allocation system that matches pediatric organs to the highest-risk
children. Another option is the greater exploitation and broader sharing of
split liver grafts. Such measures could enhance the survival of these children
to levels similar to the entire transplant population," said Rakesh Sindhi,
M.D., research assistant professor of surgery at the university of Pittsburgh's
Thomas E. Starzl Transplantation Institute and Children's Hospital of
Pittsburgh.

"Split livers, on the other hand, could essentially double the number of organs
available for transplant for both children and adults," he added.

The review of the United Network for Organ Sharing (UNOS) Scientific Registry
data of transplants performed between 1991 and 1998 showed that 4,288 of 6,028
pediatric livers were used in adults. While the number of adults who received
livers from child donors increased each year (446 in 1991 to 544 in 1998),
alternative procedures to combat the "shortage" of organs for children became
more and more commonplace. As a result, about one-third of all the pediatric
transplants now use segmental grafts, those cadaveric livers that are reduced or
split in two or those donated by a living-related adult.

The use of living-related donors, whereby a parent, in most cases, donates a
segment of his or her liver to the child, increased three-fold, from 22 in 1991
to 67 in the past few years. Surgeons also began using a technique to divide
adult cadaveric livers; children receive the smaller segment while the larger
piece is transplanted into adults. Survival for patients who receive split
livers is no different than for those who receive whole grafts. Yet while the
use of these cadaveric split liver grafts has increased more than 10 times, the
potential is not being met, the analysis shows. For instance, in 1997 there were
115 split-liver transplants performed, but there were 427 potential donors of
livers that could have been divided to benefit 854 adults and children.

Of the 29,172 liver transplants reviewed from the UNOS registry, 25,534 were in
adults and 4,186 were in children. Pediatric livers were transplanted into 4,288
adults and 2,707 children. Pediatric patients with adult livers had a lower
one-year graft survival rate than the children who received pediatric organs,
67.9 percent versus 75.5 percent. About 75 children have died each year on the
waiting list since 1991.

Under the current organ allocation system, donated organs are preferentially
used in the local area where they originate, even if there may be a patient --
adult or child -- in greater need elsewhere. Only if the organ is not placed
locally is it offered on a regional and then national basis. UNOS, which sets
organ allocation policy, is being asked by the U. S. Department of Health and
Human Services to make improvements to the system to de-emphasize geographic
factors. By order of Congress, the Institute of Medicine of the National Academy
of Sciences is currently conducting a review of the UNOS system and the
government's proposal. The report is due out this summer.

The Pittsburgh study was co-authored by John J. Fung, M.D., Ph.D., professor of
surgery and chief of transplantation at the university of Pittsburgh Medical
Center and the Starzl Transplant Institute; and Jorge Reyes, M.D., associate
professor of surgery and chief of pediatric transplantation at Children's
Hospital and the Starzl Transplant Institute.

This story has been adapted from a news release issued by university Of
Pittsburgh Medical Center.

Alan

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