Impact of length of donor ICU stay on outcome of patients after pediatric liver transplantation

BACKGROUND Organs of patients who have spent more than five days in intensive care are generally not considered for organ donation. The shortage of possible donors has encouraged us to re-evaluate, in the context of pediatric liver transplantation, this generally applied but scientifically not clearly proven rule. OBJECTIVE To determine the effects of a prolonged stay of the donor in the intensive care unit on the outcome of liver transplantation in children. METHODS We retrospectively analyzed 89 liver transplantations performed in children aged from 0 to 18 years at the Geneva University Hospitals between 2003 and 2018. Patients were divided into two groups according to their donor’s length of stay in the intensive care unit. A prolonged stay was defined as more than five days and 14 patients were included in that group and 75 in the group with a donor length of stay of five days or less. Recipient, graft and donor characteristics were compared, as well as 12 different outcome parameters, including patient and graft survival rates and postoperative complications. RESULTS Out of the 12 outcomes we analyzed, only one showed a significant difference between the two groups. Biliary complications during the first year post-transplantation were experienced by 64% of the patients who received a graft from a donor with a stay in intensive care of more than five days, compared to 32% in the group with a shorter stay (P = 0.029). Patient and graft survival rates showed a trend to be lower for patients with a prolonged donor stay, but the difference was not significant (P = 0.093 and P = 0.406, respectively). There were a few significant differences in recipient, graft and donor characteristics that could possibly have an impact on our outcomes. This should be taken into consideration for multivariate analyses in a next step. CONCLUSION Our findings suggest that the duration a donor spends in the intensive care unit does not have a significant impact on the overall outcome of pediatric liver transplantation, except for the incidence of biliary complications. Further research will be necessary to confirm our results