Journal List > J Korean Soc Transplant > v.26(3) > 1034375

TOOLS
Choi, Lee, Hong, Kim, Park, Suh, Yoo, Lee, Yi, and Suh: Status and Current Problems in the Allocation System for Pediatric Liver Transplantation in Korea
Original Article
The Journal of the Korean Society for Transplantation

The Journal of the Korean Society for Transplantation 2012; 26(3): 196-201.

Published online: 28 September 2012

DOI: https://doi.org/10.4285/jkstn.2012.26.3.196

Status and Current Problems in the Allocation System for Pediatric Liver Transplantation in Korea

Youngrok Choi, M.D., Kwang-Woong Lee, M.D., Geun Hong, M.D., Hyeyoung Kim, M.D., Min-Su Park, M.D., Sukwon Suh, M.D., Tae Yoo, M.D., Hae Won Lee, M.D., Nam-Joon Yi, M.D., Kyung-Suk Suh, M.D.

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author (kwleegs@gmail.com)

Received 4 May 2012       Accepted 18 June 2012

Copyright © 2012 The Korean Society for Transplantation

Abstract

Background

The aim of this study was to investigate the current status and identify any existing problems in the allocation system of liver transplantation (LT) for children in Korea.

Methods

The information for the period between January 2006 and March 2012 contained in the Korean Network for Organ Sharing (KONOS) database, and the 2008 and 2010 annual reports from KONOS were analyzed. Detailed information about split LT (SLT) was analyzed using the SLT database which contains data collected since 2010.

Results

Of 4,462 cases of LT between January 2006 and December 2010, 243 were pediatric cases (5.4%). Of these pediatric cases, 195 (80.2%) were living donor LT. Of the liver grafts from deceased pediatric donors, 68% were donated to adults and 3.9% were shared with children. Of the 104 splittable donors from January 2010 to March 2012, a split was performed only in 4.6% of cases. The main reason for the low split rate was few pediatric candidate(s) in the waiting list due to strict Korean regulatory requirements for split candidate registration.

Conclusions

Under the current liver transplant allocation system, Korean children have less chance to receive a liver graft from a deceased donor. With improvement of the allocation system and the rules governing SLT, children in need may have greater opportunity to receive a deceased donor graft without negatively affecting adult recipients.

Keywords: Split, Allocation, Pediatric liver transplantation

Figures and Tables

Fig. 1
Distribution of deceased donors by age (January 2006~March 2012). Values are expressed as number (%).
jkstn-26-196-g001
Fig. 2
The number of child and adult liver transplantation (LT) according to deceased donor age (January 2006~March 2012).
jkstn-26-196-g002
Fig. 3
Current allocation status of splittable donors in Korea. Among 104 splittable donors who met split donor criteria, adequate pediatric candidates were found and matched only in 29 patients (28%). However, the real split was performed only in half. Abbreviation: SLT, split liver transplantation.
jkstn-26-196-g003
Table 1
The number of liver transplantation (LT) and pediatric LT from 2006 to 2010
jkstn-26-196-i001
Table 2
Distribution of adult and pediatric deceased donors according to recipients age (January 2006~March 2012)
jkstn-26-196-i002
Table 3
The reasons for refusing the proposal of SLT (240 candidates)
jkstn-26-196-i003

Abbreviations: SLT, split liver transplantation; LT, liver transplantation.

References

1. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. Transplantation of a donor liver to 2 recipients (splitting transplantation): a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir. 1988. 373:127–130.
crossref
2. Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984. 95:367–370.
3. Rogiers X, Malago M, Habib N, Knoefel WT, Pothmann W, Burdelski M, et al. In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients. Transplantation. 1995. 59:1081–1083.
crossref
4. Goss JA, Yersiz H, Shackleton CR, Seu P, Smith CV, Markowitz JS, et al. In situ splitting of the cadaveric liver for transplantation. Transplantation. 1997. 64:871–877.
crossref
5. Suh KS, Lee KW, Koh YT, Roh HR, Chung JK, Minn KW, et al. First successful in situ split-liver transplantation in Korea. Transplant Proc. 2000. 32:2140.
crossref
6. Korean Network for Organ Sharing (KONOS). 2008 Annual Report [Internet]. 2009. cited 2012 Apr 10. Seoul: KONOS;Available from: http://konos.go.kr.
7. Korean Network for Organ Sharing (KONOS). 2010 Annual Report [Internet]. 2011. cited 2012 Apr 10. Seoul: KONOS;Available from: http://konos.go.kr.
8. Korean Network for Organ Sharing (KONOS). Regulations and guidelines for organ transplantation [Internet]. 2011. cited 2012 May 3. Seoul: KONOS;Available from: http://konos.go.kr.
9. United Nework for Organ Sharing (UNOS). Organ Distribution: Allocation of Livers [Internet]. 2011. cited 2012 Apr 10. Richmond, VI: UNOS;Available from: http://optn.transplant.hrsa.gov.
10. Lee KW, Cameron AM, Maley WR, Segev DL, Montgomery RA. Factors affecting graft survival after adult/child split-liver transplantation: analysis of the UNOS/OPTN data base. Am J Transplant. 2008. 8:1186–1196.
crossref
11. Busuttil RW, Goss JA. Split liver transplantation. Ann Surg. 1999. 229:313–321.
crossref
12. Ghobrial RM, Yersiz H, Farmer DG, Amersi F, Goss J, Chen P, et al. Predictors of survival after in vivo split liver transplantation: analysis of 110 consecutive patients. Ann Surg. 2000. 232:312–323.
13. Washburn K, Halff G, Mieles L, Goldstein R, Goss JA. Split-liver transplantation: results of statewide usage of the right trisegmental graft. Am J Transplant. 2005. 5:1652–1659.
crossref
14. Suh KS, Lee HW, Shin WY, Cho EH, Yi NJ, Lee KU. Split liver transplantation. J Korean Soc Transplant. 2007. 21:135–139.
TOOLS
Similar articles