Introduction: The first pediatric liver transplantation (LT) was performed in 1998 as a split liver transplantation and since then the number of pediatric LT cases has been increased. A pediatric LT candidate usually only needs a small volume of the liver, and this has beneficial characteristics compared to the adult recipient in terms of the number of donors and donor safety. Considering the number of pediatric LT candidates, if the number of splittable donors can be increased, split liver transplantation (SLT) can substitute living donor liver transplantation. Also in the past decades, with the effort of deceased donation program and changes of policy, the number of deceased donor liver transplantation (DDLT) and the proportion of SLT has been increased up to about 50% and 5% respectively. Therefore we reviewed the number and type of pediatric LT in Seoul National University hospital (SNUH) according to the changes of the allocation system.
Methods: We reviewed pediatric LT recipients who received LT in SNUH from Jan. 2000 to Dec. 2016. Patients less than 16 years old were included. The policy of Korean Network for Organ Sharing has changed. Pediatric recipients could not be an SLT candidate if his/her parents did not have reasons to be an unsuitable liver donor (i.e., ABO incompatibility, HBsAg (+), Anti-HCV (+) etc.). This regulation was deleted in January 2013. The regulation has also been revised regarding the usage of inotropics. The following medications: dobutamine, norepinephrine, and epinephrine were added in January 2014 and usage of vasopressin was deleted in October 2014.
Results: The total number of pediatric LT recipients was 179 during the 17 years. The number and the proportion of DDLT has been increased to 100% in 2016. From 2000 to 2009 the proportion of DDLT was 0% to 23%, but from 2010 it had started to continuously increase to reach 100% in 2016. The total number of pediatric LT recipients annually had decreased but all of those 3 pediatric LT recipients were substituted to DDLT in 2016.
Conclusion: With the increase in the number of DDLT and SLT, pediatric LDLT can be replaced by DDLT in the future.