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Technical Variant Graft Usage Affects Pediatric Liver Transplant Waitlist Mortality

Higher technical variant graft usage from living or deceased donor linked to lower waitlist mortality in pediatric liver transplant candidates

By Elana Gotkine HealthDay Reporter

FRIDAY, July 21, 2023 (HealthDay News) — For pediatric liver transplant (LT) candidates, higher technical variant graft (TVG; including living donor [LD] and deceased donor split/partial grafts) usage is associated with lower waitlist (WL) mortality, according to a study published in the July issue of Liver Transplantation.

George V. Mazariegos, M.D., from the UPMC Children’s Hospital of Pittsburgh, and colleagues conducted a retrospective analysis of Organ Procurement and Transplantation Network data on first-time LT or liver-kidney pediatric candidates listed at centers performing more than 10 LTs during 2004 to 2020. LT volume, TVG usage, and survival were assessed at 64 centers performing 7,842 LTs.

The researchers found that the proportions of WL mortality varied from 0 to 31 percent by center, and TVG usage varied from 0 to 76 percent. There was a significant association for higher TVG usage, from deceased donor or LD, independently or in combination, with lower WL mortality. Death from listing was significantly lower with increased center TVG usage and LT volume in a multivariable analysis (hazard ratios [95 percent confidence intervals], 0.611 [0.40 to 0.92] and 0.995 [0.99 to 1.00], respectively). Compared with other graft types, recipients of LD transplants had significantly increased survival from transplant (hazard ratio, 0.637; 95 percent confidence interval, 0.51 to 0.79). Outcomes were similar for recipients of deceased donor TVGs versus whole graft recipients (hazard ratio, 1.066; 95 percent confidence interval, 0.93 to 1.22).

“This analysis demonstrates the impact of TVG usage and LD liver grafts on the reduction and potential elimination of pediatric WL mortality in the United States,” the authors write.

One author disclosed ties to industry.

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