{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:40:47Z","timestamp":1788021647880,"version":"build-2784847793"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T00:00:00Z","timestamp":1563840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>This study estimated the utility of technical variant grafts (TVGs), such as split\/reduced liver transplantation (SRLT) and living donor liver transplantation (LDLT), in pediatric acute liver failure (PALF). PALF is a devastating condition portending a poor prognosis without liver transplantation (LT). Pediatric candidates have fewer suitable deceased donor liver transplantation (DDLT) donor organs, and the efficacy of TVG in this setting remains incompletely investigated. PALF patients from 1995 to 2015 (age &lt;18\u00a0years) were identified using the Scientific Registry of Transplant Recipients (n\u00a0=\u00a02419). Cox proportional hazards model and Kaplan\u2010Meier curves were used to assess outcomes. Although wait\u2010list mortality decreased (19.1% to 9.7%) and successful transplantations increased (53.7% to 62.2%), patients &lt;1\u00a0year of age had persistently higher wait\u2010list mortality rates (&gt;20%) compared with other age groups (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). TVGs accounted for only 25.7% of LT for PALF. In the adjusted model for wait\u2010list mortality, among other factors, increased age (subhazard ratio [SHR], 0.97 per year; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.020) and access to TVG were associated with decreased risk (SHR, 0.37; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.0001). LDLT recipients had shorter median waiting times compared with DDLT (LDLT versus DDLT versus SRLT, 3 versus 4 versus 5\u00a0days, respectively; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.017). In the adjusted model for post\u2010LT survival, LDLT was superior to DDLT using whole grafts (SHR, 0.41; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.004). However, patient survival after SRLT was not statistically different from DDLT (SHR, 0.75; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.165). In conclusion, despite clear advantages to reduce wait\u2010list mortality, TVGs have been underutilized in PALF. Early access to TVG, especially from LDLT, should be sought to further improve outcomes.<\/jats:p>","DOI":"10.1002\/lt.25499","type":"journal-article","created":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T14:21:14Z","timestamp":1558621274000},"page":"1241-1250","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Improved Survival Following Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Analysis of 20 Years of US National Registry Data"],"prefix":"10.1097","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7993-6167","authenticated-orcid":false,"given":"Daniel J.","family":"Firl","sequence":"first","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McVey","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Hupertz","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Pediatric Gastroenterology,Pediatric Institute, Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadakkal","family":"Radhakrishnan","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Pediatric Gastroenterology,Pediatric Institute, Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Fujiki","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijan","family":"Eghtesad","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles M.","family":"Miller","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano","family":"Quintini","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine,Cleveland Clinic,Cleveland,OH"},{"name":"Departments of General Surgery, Digestive Disease and Surgery Institute,Cleveland 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