title: Split and whole liver transplantation outcomes: a comparative cohort study.
abstract: 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.
authors.affiliation: Transplant Immunology and Blood Bank, Maggiore Policlinico Hospital, Milano, Italy. massimo.cardillo@policlinico.mi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Cardillo
authors.forename: Nicola
authors.initials: N
authors.lastname: De Fazio
authors.forename: Paola
authors.initials: P
authors.lastname: Pedotti
authors.forename: Tullia
authors.initials: T
authors.lastname: De Feo
authors.forename: Luigi Rainero
authors.initials: LR
authors.lastname: Fassati
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.forename: Lucio
authors.initials: L
authors.lastname: Caccamo
authors.forename: Luciano
authors.initials: L
authors.lastname: DeCarlis
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Mariangelo
authors.initials: M
authors.lastname: Cossolini
authors.forename: Cristiano
authors.initials: C
authors.lastname: Martini
authors.forename: Adelmo
authors.initials: A
authors.lastname: Antonucci
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Mario
authors.initials: M
authors.lastname: Scalamogna
mesh_terms: 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