Background: Whole deceased donor liver transplantation (DDLT) in small pediatric recipients (defined as children < 10 Kg) is mostly limited by unavailability of suitable graft, technical challenges and questionable function of a young graft. Actually less than 35% of patients younger than 1 year of age receive a whole-DDLT. 2-years patient and graft survival are reported about 90% and 80% respectively. Overall morbidity is approximally 45%. Vascular and biliary complication have been observed in up to 25% and 7.5% after whole-DDLT respectively. A donor-to-recipient weight ratio (DRWR)<1,5 is considerd as risk for complications.
Aim of the study is to determine the outcomes after whole-DDLT in small pediatric recipients.
Methods:  We retrospectively analysed all pediatric whole-DDLT between 2005 and 2016 at our centre and evaluated the patient and graft survival and the surgical complications in small children with a weight less than 10 kg.
Results: From 2005  to  2016 we performed 35 whole-DDLT. 12 of them (35%) weighed less than 10kg (median weight 6,1kg (3,5-8,3) at a median age of 10 months (10 days-24 months)). The donors’ median weight was 6,75kg (4-16kg) and median age 6 months (1-36 months). The median DRWR was 1,2 (0,6-4). The indications of LT were cholestatic disorders in 9 patients and metabolic liver diseases in 3. No delayed closure or a patch was needed. Primary function rate was 100%. 3 patients experienced biliary complications and one patient kinking of the hepatic artery. All of them were reoperated. After a median follow-up-time of four years (7-84 months) graft survival is 100%. Overall patient survivals were 100% and 92% at 2 and 5 years, as one patient died at POM  34 because of HSV sepsis.
Conclusion: Excellent results can be achieved in whole-DDLT in small recipients despite a DRWR<1,5.