To investigate the feasibility and safety of liver graft from little-month-old donors in pediatric liver transplantation.

Clinical data of 101 donors and recipients undergoing liver transplantation from January 2014 to December 2016 in Tianjin First Central Hospital were retrospectively analyzed. 46 recipients were male and 55 female, aged 5.8-40.5 months with a median age of 9.0 months. According to the age of donors, all recipients were divided into the extremely little-month-old group (n=26), little-month-old group (n=22) and normal-month-old group (n=53). The informed consents of all parents of donors were obtained and the local ethical committee approval was received. The perioperative conditions, postoperative complications and survival rate of grafts and recipients were statistically compared and analyzed. The rate comparison was conducted by Chi-square test or Fisher's exact probability test. The survival analysis was performed by Log-rank test.

The incidence of hepatic arterial thrombosis in the extremely little-month-old group was 38% (10/26), significantly higher than 13% (7/53) in the normal- month-old group (χ²=6.6, P<0.017). The incidence of postoperative small-for-size syndrome was 23% (6/26) in the extremely little-month-old group, significantly higher than 0 in the little-month-old and normal-month-old groups (P<0.05). In the extremely little-month-old group, the incidence of acute rejection was 4%(1/26), significantly lower than 27%(6/22) in the little-month-old group (χ²=5.3, P<0.017). The 3-year survival rates of liver graft in 3 groups were 88.5%, 95.5% and 90.6%, respectively, and no significant difference was observed (χ²=0.4, P>0.05). The 3-year cumulative survival rates of the recipients in three groups were 92.3%, 95.5% and 94.3%, respectively, and no significant difference was observed (χ²=0.2, P>0.05).

Under strict selection, the liver graft from little-month-old donors can be safely used in pediatric liver transplantation. The incidence of arterial thrombosis and small-for-size syndrome in the recipients is high, however, the overall survival is not affected. Besides, it possesses the advantage of immune tolerance.