Abstract

Background: Since our first pediatric anonymous non-directed live donor liver transplant (Anon-LDLT) performed in April 2005, 62 children have undergone live donor liver transplant (LDLT) with an anonymous non-directed graft. Anon-LDLT organs being allocated as per our deceased donor liver transplant wait list. The objective of this study was to evaluate clinical outcomes, recipient characteristics and social determinants of health of pediatric recipients of Anon-LDLT in comparison to those who received a directed LDLT (Dir-LDLT).

Methods: Retrospective analysis of all recipients of LDLT performed between January 2005 and March 2023. Demographic and clinical data included age, sex, race, ethnicity, single-parent households, primary diagnosis, recipient blood type, time on waiting list, post-LT intensive care unit (ICU) length of stay (LOS), time to extubation, and post-transplant comorbidities were assessed as covariates. A comparative analysis was conducted between children receiving Anon-LDLT versus Dir-LDLT. A p value of ≤0.05 was considered significant.

Results: A total of 236 (51% male, 62% white, 19.5% Asian, 7% Black, 3% indigenous) children (median age 11 months) underwent LDLT. Biliary atresia (44%) and metabolic diseases (31%) were the commonest primary indications. Anon-LDLT was performed in 62 (26.2%) children, none of whom had any directed live liver donor options. Recipients of Anon-LDLT were more often non-white (55% vs 32%, p=0.001), Black (13% vs 5%, p=0.043) and Indigenous (8% vs 2%, p=0.018) recipients in comparison to Dir-LDLT recipients. Anon-LDLT recipients were more frequently living in single parent households (18% vs 3%, p<0.001) and to require interpreter assistance (11% vs 3%, p=0.010) (Table), compared to children who received a Dir-LDLT. Out-of-province children were more likely to undergo Anon-LDLT (19/62, 31%) compared to Dir-LDLT (31/174, 18%, p=0.034). Median time on the wait list was longer for Anon-LDLT (92 days) compared to Dir-LDLT (62 days) recipients (p=0.004). Post-LT ICU LOS, time to extubation or other post-LT complications were not statistically different between groups. There were no cases of graft failure or re-transplantation in the Anon-LDLT recipients.

Conclusion: This retrospective analysis of 62 children undergoing Anon-LDLT at a single institution confirms excellent patient and graft survival. Patients from Indigenous and Black communities, single parent and households where English is a second language, are more frequently the beneficiaries of Anon-LDLT grafts. Anon-LDLT, as utilized in this single center analysis, benefits medically underserved pediatric patients who otherwise have limited access to the advantages of LDLT.