Dieguez Hernandez Vaquero I, Bueno Jimenez A, Salim AM, Vilca-Melendez H, Sanabria Mateos R, Valamparampil JJ, Ong E, Gupte GL, Sharif K. Donor size and early vascular complications in children receiving a whole liver transplant. World J Transplant 2026; 16(2): 115702 [DOI: 10.5500/wjt.v16.i2.115702]
Corresponding Author of This Article
Irene Dieguez Hernandez Vaquero, Liver Unit, Birmingham Children’s Hospital, Steelhouse Ln, St. Chads Tunnel, Birmingham B4 6NH, United Kingdom. dieguez.irene@nhs.net
Research Domain of This Article
Transplantation
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research-article
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Dieguez Hernandez Vaquero I, Bueno Jimenez A, Salim AM, Vilca-Melendez H, Sanabria Mateos R, Valamparampil JJ, Ong E, Gupte GL, Sharif K. Donor size and early vascular complications in children receiving a whole liver transplant. World J Transplant 2026; 16(2): 115702 [DOI: 10.5500/wjt.v16.i2.115702]
World J Transplant. Jun 18, 2026; 16(2): 115702 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115702
Donor size and early vascular complications in children receiving a whole liver transplant
Irene Dieguez Hernandez Vaquero, Alba Bueno Jimenez, Areej M Salim, Hector Vilca-Melendez, Rebeca Sanabria Mateos, Joseph J Valamparampil, Evelyn Ong, Girish L Gupte, Khalid Sharif
Irene Dieguez Hernandez Vaquero, Alba Bueno Jimenez, Areej M Salim, Hector Vilca-Melendez, Rebeca Sanabria Mateos, Joseph J Valamparampil, Evelyn Ong, Girish L Gupte, Khalid Sharif, Liver Unit, Birmingham Children’s Hospital, Birmingham B4 6NH, United Kingdom
Hector Vilca-Melendez, Rebeca Sanabria Mateos, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
Author contributions: Bueno Jimenez A and Sharif K designed the research study and supervised the entire process; Dieguez Hernandez Vaquero I and Salim AM developed the methods, collected the data and performed the statistical analysis; Dieguez Hernandez Vaquero I wrote the original draft; Bueno Jimenez A, Vilca-Melendez H, Sanabria Mateos R, Valamparampil J, Ong E, Gupte GL, Sharif K, provided patients and were involved in their medical care; Also reviewed the last version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the (Institution’s Research & Development office) Institutional Review Board, No. 39/BWC/LA/Dieguez.
Informed consent statement: This study was registered with the Institution’s Research & Development office and in accordance with the United States National Research Ethics Service guidance, neither individual informed consent nor formal research ethics committee review was required as the study was undertaken by the direct clinical care team using information previously collected in the course of routine care.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dieguez.irene@nhs.net.
Corresponding author: Irene Dieguez Hernandez Vaquero, Liver Unit, Birmingham Children’s Hospital, Steelhouse Ln, St. Chads Tunnel, Birmingham B4 6NH, United Kingdom. dieguez.irene@nhs.net
Received: October 27, 2025 Revised: December 15, 2025 Accepted: January 22, 2026 Published online: June 18, 2026 Processing time: 218 Days and 14.1 Hours
Abstract
BACKGROUND
Early vascular complications are one of the leading causes of morbidity and graft loss in paediatric whole liver transplant (WLT). It has been previously suggested that the donor size might influence these outcomes, but evidence remains insufficiently defined.
AIM
To evaluate the influence of donor weight on the incidence of early vascular complications after WLT in paediatric recipients.
METHODS
Single-centre, retrospective cohort study on patients under 18 years old, who received a first WLT between 2000 and 2024. Recipients were classified according to the donor’s weight: Subgroups A (≤ 15 kg) and B (> 15 kg). Demographic, anthropometric, surgical and perioperative variables were analysed, focusing on early vascular complications - hepatic artery thrombosis (HAT), portal vein thrombosis (PVT) - and the need for re-transplantation within 30 days postoperatively.
RESULTS
Sixty-four patients met the inclusion criteria. Subgroup A (n = 12) showed higher rates of early complications compared with subgroup B (n = 52): HAT 25% vs 5.8% [relative risks (RR): 4.3, 95%CI: 1.0-18.9, P = 0.074], PVT 16.7% vs 1.9% (RR: 8.7, 95%CI: 0.9-87.9, P = 0.088), and re-transplantation 16.7% vs 0% (RR: 5.4, 95%CI: 0.9-32.0, P = 0.033). Donor and recipient anthropometrics were highly correlated, precluding assessment of donor weight as an independent risk factor.
CONCLUSION
In paediatric WLT, grafts from small donors appear more susceptible to early vascular complications, reflecting the technical and anatomical vulnerability of small-calibre vessels rather than donor weight alone. Awareness of this relationship may assist in graft selection, intraoperative planning and postoperative surveillance.
Core Tip: This single-centre study evaluates the impact of donor size on early vascular complications after paediatric whole liver transplantation. Grafts from donors ≤ 15 kg showed higher rates of early vascular complications and retransplantation. Although donor weight itself was not an independent risk factor, it reflects the anatomical and technical challenges of small-calibre vessels. Recognising this association may help optimise graft selection, surgical planning, and postoperative monitoring to improve outcomes in small paediatric recipients.
