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Achieving zero waitlist mortality for children on the pediatric liver transplant waitlist
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DOI：10.1016/j.ajt.2026.03.025.png)
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Abstract
En 中文
Children with end-stage liver disease are at high risk of waitlist morbidity and mortality; children <1 year have the highest mortality of all age groups in the US (18.6 deaths per 100 patient-years). Pediatric candidates receive fewer offers of organs than adults, and excessive wait-times contribute to delays in development that can have lasting impact. Policy changes and outreach efforts have been insufficient to increase organ availability for children. Living donor liver transplantation (LDLT) is underutilized in the US, accounting for 14.6% of all pediatric transplants in 2023, compared with 46.2% in Canada. The ASTS Pediatric Committee therefore recommends promoting increased utilization of LDLT and incentivization and adoption of mandatory liver-splitting policies to safeguard these children, which could decrease pediatric waitlist mortality while increasing the number of liver transplants performed. Outcomes are similar between recipients of split-liver and whole-liver grafts in both pediatric and adult populations, but fewer than 5% of potentially splitable livers are currently used for split-liver transplantation in the US. In contrast, over 65% of pediatric patients in the United Kingdom receive a split-liver allograft, with excellent survival. Use of a center-based allocation system will support this mandate by reducing cold ischemia time and increasing liver availability.
Keywords:
pediatric liver transplantation
living donor liver transplantation
liver splitting
waitlist mortality
organ allocation
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