Introduction: The scarcity of paediatric donors has led some units to use larger donors and perform graft reduction to overcome the shortage of small size matched full grafts. The aim of this study was to compare the outcome of patients receiving reduced grafts to those with full size grafts.
Method: The records of 94 Itx performed were reviewed. Patients were divided in two groups, reduced grafts (Group 1) and full size grafts (Group 2) and their details were compared.
Results: 94 Itx were performed in 87 patients, 23 with reduced grafts, 19 Liver and Itxx and 4 Isolated Itx. Demographics are shown in Table1
Table 1: Demographic aspects
| Characteristics | Group 1 | Group 2 |
| Recipient Age in months | 15 (7-138) | 40.5 (8-194) |
| Recipient Weight in kg | 8.4 (5.58-31) | 12.8 (6.53-52) |
| Recipient Weight z score | -1.95 (-6.14 to -0.24) | -1.336 (-4.24 to -1.6) |
| Recipient Surgical procedures | 2(1-*) | 2(0-8) |
| Recipient Residual length | 29 | 60 |
| Donor age | 108 (12-480) | 72 (2-492) |
| Donor weight | 30 (12-70) | 21 (4.5-70) |
| D: R weight ratio | 2.7 (1.3-6) | 1.34 |
The length of intestinal resection varied from 45cm to 212cm, usually performed in the mid gut. The cold ischaemic time was a median of 422 minutes in Group 1 and 382 minutes in Group 2. With respect to abdominal closure, both groups had the same incidence of primary closure (56, 62%), however the use of an abdominal prosthesis was commoner in Group 2 (17% vs. 9%). Feeds were started in a median time of 6 days in Group 1 and 5 days in Group 2, while PN was stopped 26 days after SBTx in Group 1 and 18 days in Group 2 (median). Main complications are shown in Table 2.
Table 2 : post-transplant complications
| Group1 | Group2 | |
| Intestinal leak (%) | 9.36 | 17.46 |
| Perforation (%) | 27.27 | 14.75 |
| Post-compartmental syndrome | 22.72 | 4.76 |
| PTLD | 22.94 | 20.96 |
| GVHD (%) | 13.63 | 11.47 |
| Acute rejection (%) | 1 (0-6) | 2(0-6) |
| Chronic rejection (%) | 18.18 | 8.06 |
| Survival time (days) | 1018 (8-6478) | 1405 (1-6842) |
Discussion : Children receiving reduced grafts were younger, more likely to be inpatients at the time of transplant, had longer post-operative ICU and hospital stay, and were transplanted with older donors and with higher D/R weight ratio. This decision of reducing a graft could be influenced by the severity of illness in these patients.
Conclusion : Children with reduced grafts can have a successful long-term outcome comparable with full size grafts
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