Split and whole liver transplantation outcomes: a comparative cohort study.
A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1,126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow-up of 22 months, SLTs achieved a 3-yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, <50 annual transplants volume, urgent transplantation (United Network for Organ Sharing (UNOS) status I and IIA), ischemia time of >7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in-list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique.
Cardillo
Massimo
M
Transplant Immunology and Blood Bank, Maggiore Policlinico Hospital, Milano, Italy. massimo.cardillo@policlinico.mi.it
De Fazio
Nicola
N
Pedotti
Paola
P
De Feo
Tullia
T
Fassati
Luigi Rainero
LR
Mazzaferro
Vincenzo
V
Colledan
Michele
M
Gridelli
Bruno
B
Caccamo
Lucio
L
DeCarlis
Luciano
L
Valente
Umberto
U
Andorno
Enzo
E
Cossolini
Mariangelo
M
Martini
Cristiano
C
Antonucci
Adelmo
A
Cillo
Umberto
U
Zanus
Giacomo
G
Baccarani
Umberto
U
Scalamogna
Mario
M
D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007558:Italy; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome