A study by Johns Hopkins University has concluded that alternatives to whole liver transplant (WLT) in pediatric patients have become safer in the recent years and should be used more widely to increase the supply of donated organs. Published in The Journal Pediatrics, the findings mean more patients stand to receive life-saving transplants through the use of partial liver transplants from either deceased or living donors.

"Our study indicates that while there were initially worse outcomes when a whole liver from a deceased donor was given to two recipients, known as a 'split liver transplant,' outcomes are now similar to the classic liver transplant, when a whole liver is given to one recipient. Additionally, outcomes when a living donor gives a portion of his or her liver may actually be superior to a whole liver transplant," said Dr. Douglas B. Mogul, the study's lead author who is an assistant professor of pediatrics at the Johns Hopkins University School of Medicine.

In a whole liver transplant, the entire organ is transplanted from a deceased donor into the patient in need. A split organ transplant calls for the liver to be cut in half and received by two recipients. During a living organ liver transplant, a portion of a living person's organ is transplanted into the recipient. The donor's liver regenerates on its own.

The study looked at survival rates for pediatric patients between 2002 and 2015. Researchers identified 5,175 pediatric, liver-only transplant recipients who had received an organ in the 15-year period following the implementation of the Pediatric End-stage Liver Disease (PELD) or Model for End-stage Liver Disease (MELD) system. The models score potential liver recipients on how urgently they will need a transplant in the following three-month period.

Of the study subjects, 60 percent had received a whole liver transplant, 28.5 percent received a split liver transplant and 11.6 received a living donor liver transplant.

The 30-day survival rate for split liver transplants increased from 94 to 98 percent, and the one-year survival rate increased from 89 to 95 percent. The one-year survival rate for living donor transplant recipients also increased from 93 percent to 98 percent. Survival rates did not change for whole liver transplant recipients, either at the 30-day mark or one year.

For a portion of the study period (2002 to 2009), the risk of early death with split organ transplant was 2.14 times higher; however, the risk disappeared entirely during the last five years of the study.

Other findings of note include:

• Split liver transplant and living donor recipients were more likely to be under 2 years old and weigh less than 22 pounds.
• African-Americans were less likely than Caucasians to receive a living organ transplant and more likely to receive a whole liver transplant.
• Living donors were between the ages of 18-50. Whole liver transplant donors were between 0-17.

"A recent report tells us that nearly half of all children who died while on the wait list didn't receive a single offer for an organ," Mogul said. "Our findings, which show that overall patient and graft survivals have improved, and that outcomes for alternatives to WLT are comparable, will hopefully influence policy for organ allocation such as greater use of split liver transplantation."