title: Long-term outcome of split liver transplantation using right extended grafts in adulthood: A matched pair analysis.
abstract: OBJECTIVE
  Shortage of suitable organs led to the development of alternative techniques in liver transplantation. Split liver transplantation (SLT) is well established in pediatric patients. SLT is not completely accepted in adult recipients due to potential increased risk of complications. Despite satisfying results of short-term outcome, there is a leak on information of the long-term outcome. Therefore, we compared the outcome after transplantation of the right extended liver lobe with whole liver transplantation (WLT) using a matched pair's analysis.
  
  
  METHODS
  From the period of January 1993 to February 2005, 70 SLT recipients were matched with 70 WLT recipients of whole livers. Matching criteria were: 1) indication for transplantation, 2) United Network for Organ Sharing (UNOS) status, 3) recipient age, 4) donor age, 5) cold ischemic time, and 6) year of transplantation. The outcome was analyzed retrospectively.
  
  
  RESULTS
  Mean follow-up was 36 months. The 2- and 5-year patient survival rates after SLT and WLT were 86.3% and 82.6%, and 78.4% and 75.6%, respectively (log rank, P = 0.2127). Two- and 5-year graft survival rates were 77.3% and 77.3% after SLT and 71.9% and 65.8% after WLT, respectively (log rank, P = 0.3822). The total biliary complication rate was 11.4% in the SLT group versus 10.0% in the WLT group in the short-term course, while it was 8.5% after SLT and 10.0% after WLT in the long-term course. We did not observe significant differences between the groups in term of short- and long-term morbidity.
  
  
  CONCLUSIONS
  Transplantation of the right extended lobe deriving from left lateral splitting of deceased donor livers is followed by the same long-term patient and graft survival, which is known from WLT. There were no differences in the complication rates even in long-term outcome implementing that SLT does not put the adult recipient to an increased early and late risk. Transplantation of the extended right liver lobe provides a safe and efficient procedure in adult patients to expand the number of available grafts.
authors.affiliation: Department of Hepatobiliary Surgery and Solid Organ Transplantation, University Hospital Hamburg Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wilms
authors.forename: Jessica
authors.initials: J
authors.lastname: Walter
authors.forename: Maren
authors.initials: M
authors.lastname: Kaptein
authors.forename: Lars
authors.initials: L
authors.lastname: Mueller
authors.forename: Christian
authors.initials: C
authors.lastname: Lenk
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
authors.forename: Christian
authors.initials: C
authors.lastname: Hillert
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome