The impact of donor-recipient weight ratios on outcomes after pediatric deceased donor whole-liver transplantation

• Published in: Journal of liver transplantation 2025-02, Vol.17, Article 100249
• Main Authors: McGeoghegan, Patrick B., Miggins, John J., Crawford, Megan, Sugarbaker, Evert, Rana, Abbas
• Format: Article
• Language: English
• Subjects: Body surface area; Deceased donor; Liver; Pediatric; Transplant; Weight
• ISSN: 2666-9676; 2666-9676
• DOI: 10.1016/j.liver.2024.100249

•Donor-recipient weight ratios (WR) may predict poor outcomes in pediatric DDLT.•A WR ≤ 0.70 and WR > 2.0 may increase risk of poor outcomes.•Size-matching ratios do not seem to be useful for biliary atresia or significant ascites. It has been shown that recipients receiving grafts from both undersized and oversized donors have worse clinical outcomes. However, donor-recipient size (DR) mismatch is an understudied metric in pediatric whole-liver deceased donor liver transplantation (DDLT). Here, we analyzed the utility of both DR weight ratio (WR) and body surface area ratio (BSAR) in predicting outcomes among all pediatric whole-liver DDLT recipients. We also performed subgroup analyses for patients with biliary atresia (BA) as well as for other diagnoses with ascites to evaluate these ratios’ utility among patients with increased abdominal domain. We evaluated all pediatric patients undergoing primary whole-liver DDLT within the UNOS database from 3/1/2002–1/23/2023. We identified 5286 patients 2.0) were associated with increased hazard of graft failure and death. The 90th percentile WR for graft survival was 1.61 (95 % CI 1.22, 2.13, p = 0.001). Bottom 10th WR percentile for patient survival was 1.46 (95 % CI 1.14, 1.88, p = 0.01), while the >90th WR for patient survival was 1.54 (95 % CI 1.28, 2.23, p < 0.001). Only the >90th percentile WR (HR 0.8