title: Split liver transplantation and risk to the adult recipient: analysis using matched pairs.
abstract: BACKGROUND
  The technique of liver splitting is an effective way of increasing the donor pool and reducing pediatric waiting list mortality. But the procedure is still not fully accepted because of concerns that it may cause complications in adult recipients.
  
  
  METHODS
  Fifty-nine adult recipients of primary extended right split liver transplantations (SLTs) were matched to recipients of whole liver transplantations (WLTs) according to the following criteria: 1) United Network for Organ Sharing (UNOS) status, 2) donor age, 3) recipient age, 4) total cold ischemic time, 5) indication for liver transplantation, 6) Child-Pugh class, and 7) year of transplantation. A WLT-recipient match was identified in 40 adult recipients of primary SLT.
  
  
  RESULTS
  Fifteen percent of the recipients in our study were highly urgent cases (UNOS 1), and 85% were UNOS status 3-4. The 3- and 12-month patient survival rates after SLT and WLT were 82.5% and 77.1%, and 92.5% and 87.5%, respectively (log rank p = 0.358). The 3- and 12-month graft survival rates showed no significant difference in either group (80% and 74% in SLT and 87.5% and 77.4% in WLT [log rank p = 0.887]). The rates of primary nonfunction, primary poor function, biliary and vascular complications, intra- and postoperative blood transfusion, and intensive care stay were comparable for SLT and WLT.
  
  
  CONCLUSIONS
  SLT, using the extended right hepatic lobe, does not notably differ from WLT with regard to initial graft function, postoperative complications, or patient and graft survival. Based on this, the liver can be considered a paired organ, and mandatory splitting of good-quality livers can be recommended.
authors.affiliation: Department of Hepatobiliary Surgery and Transplantation, University Hospital-Eppendorf, University of Hamburg, Germany.
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Stefan
authors.initials: S
authors.lastname: Topp
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schaefer
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Matthias
authors.initials: M
authors.lastname: Gundlach
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
authors.forename: Volker
authors.initials: V
authors.lastname: Schoder
authors.forename: Werner
authors.initials: W
authors.lastname: Pothmann
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis