Utility of Low‐Weight Grafts From Young Pediatric Donors in Children Liver Transplantation: Is There a Limit of Whole Graft Weight?

Background Low‐weight grafts from young pediatric donors are considered a risk factor for surgical complications. However, the limited availability of age‐ and size‐matched organs has prompted a re‐evaluation of low‐weight grafts from young pediatric donors. Methods From January 1, 2019, to December 31, 2023, 52 pediatric liver transplants receiving young pediatric donors (≤ 2 years old) with low body weight (≤ 15 kg) were performed. According to graft weights (GW), recipients were divided into two groups: Group 1 (GW ≤ 150 g) and Group 2 (GW: 151–400 g), to compare donor and recipient characteristics, postoperative complications, and graft and recipient survival. Results Group 1 donors were younger (5.4 ± 4.2 vs. 14.4 ± 4.7 months, p < 0.001), smaller in body length (58.0 ± 8.7 vs. 75.7 ± 8.5 cm, p < 0.001), and lighter in weight (6.2 ± 2.8 vs. 10.0 ± 2.0 kg, p < 0.001) compared to Group 2. There were no significant differences in preoperative laboratory tests between groups, and the incidences of vascular complications were also similar between the groups. The 1‐ and 3‐year patient survival rates were 100% and 100% in Group 1 vs. 97% and 97% in Group 2, respectively. The 1‐ and 3‐year graft survival rates were 100% and 91% in Group 1 vs. 97% and 97% in Group 2, with no significant differences. The smallest graft, weighing 86 g, yielded an ideal outcome for the recipient. Conclusions Low‐weight grafts from young pediatric donors can achieve excellent outcomes and represent a potential strategy to increase donor availability for well‐selected pediatric recipients.