IMPROVING OUTCOMES FOR CHILDREN WITH END-STAGE LIVER DISEASE THROUGH GREATER USE OF TECHNICAL-VARIANT GRAFTS

Pediatric liver transplantation provides life-saving therapy to children with end-stage liver disease but more widespread use is greatly hindered by the availability of deceased donor organs. Newer surgical techniques that use partial grafts (i.e., “technical-variant transplantation), including living-donor liver transplantation (LDLT) and split liver transplantation (SLT), allow for opportunities to increase the supply of organs and reduce waitlist mortality and morbidity. To understand the potential benefit of these technical-variants grafts, we first conducted an analysis of patient and graft survival using the Scientific Registry of Transplant Recipients (SRTR) to determine if there was a change in outcomes over time associated with use of these newer surgical procedures. We subsequently explored outcomes for children on the liver transplant waitlist using SRTR and determined how waitlist outcomes, including living donation, vary based on sociodemographic characteristics. In order to better understand why African Americans and individuals on public assistance use LDLT at lower rates, we conducted a survey of potential barriers for parents of children with ESLD or transplant recipients including an assessment of their understanding of LDLT, its process, risks and harms. Finally, we performed an analysis of effect modifiers for SLT using SRTR data to identify which candidates had worse relative outcomes with SLT compared to WLT, and which candidates had similar outcomes irrespective of graft type. We determined that, for pediatric (