title: Donor and recipient selection leads to good patient and graft outcomes for right lobe split transplantation versus whole graft liver transplantation in adult recipients.
abstract: The outcomes of right lobe split (RLS) liver transplantation are variable in adult recipients. This report is an analysis of outcomes of our initial 5-year experience with the right lobe trisegment split graft. A retrospective analysis was performed of the recipient and graft outcomes from July 2002 to March 2007 of all adult recipients of RLS grafts versus recipients of whole grafts (WGs). All data were analyzed with Stata version 8 (Stata Corp., Texas). There were 43 (19.1%) RLS recipients and 182 (80.9%) WG recipients. The median Model for End-Stage Liver Disease score was 13 (7-23) in the RLS group and 18 (6-50) in the WG group (P < 0.001). Hepatocellular carcinoma and primary sclerosing cholangitis were more common in the RLS group (P < 0.05), whereas alcoholic cirrhosis and chronic hepatitis C were more common in the WG group. The median donor age was lower in the RLS group at 39 (13-61) years versus the WG group at 47 (12-79) years (P < 0.001). Primary nonfunction occurred in 1.6% of the WG patients only. Biliary complications occurred in 28% of the RLS patients versus 28% of the WG patients. Vascular complications occurred in 18% of the RLS patients versus 14% of the WG patients. The retransplantation rate was similar at 2.3% in the RLS group versus 4.9% in the WG group (P = not significant). Overall 3-year recipient survival was 92.7% in the RLS group versus 82.7% in the WG group (P = 0.284). Graft survival was 88.4% in the RLS group at 3 years versus 78.5% in the WG group (P = 0.304). In conclusion, good outcomes can be achieved with RLS liver transplantation in adult recipients without a detrimental effect on recipient or graft survival.
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia. csandrou@hotmail.com
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
authors.forename: Michael
authors.initials: M
authors.lastname: Crawford
authors.forename: David S
authors.initials: DS
authors.lastname: Lockwood
authors.forename: Patrick
authors.initials: P
authors.lastname: Tang
authors.forename: James P
authors.initials: JP
authors.lastname: Gallagher
authors.forename: Henry
authors.initials: H
authors.lastname: Pleass
authors.forename: Simone I
authors.initials: SI
authors.lastname: Strasser
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Shackel
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: McCaughan
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Verran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult