title: Outcomes in partial liver transplantation: deceased donor split-liver vs. live donor liver transplantation.
abstract: BACKGROUND
  Organ shortage has resulted in greater emphasis on partial liver transplantation (PLT) as an alternative to whole-organ liver transplantation.
  
  
  METHODS
  This study was conducted to assess outcomes in PLT and to compare outcomes of deceased donor split-liver transplantation (DD-SLT) and live donor liver transplantation (LDLT) in adults transplanted in the USA using data reported to the United Network for Organ Sharing in the era of Model for End-stage Liver Disease (MELD) scores.
  
  
  RESULTS
  Between 2002 and 2009, 2272 PLTs were performed in the USA; these represented 5.3% of all liver transplants carried out in the country and included 557 (24.5%) DD-SLT and 1715 LDLT (75.5%) procedures. The most significant differences between the DD-SLT and LDLT groups related to mean MELD scores, which were lower in LDLT recipients (14.5 vs. 20.9; P < 0.001), mean recipient age, which was lower in the LDLT group (50.7 years vs. 52.8 years; P < 0.001), and mean donor age, which was lower in the DD-SLT group (23.0 years vs. 37.3 years; P < 0.001). Allograft survival was comparable between the two groups (P= 0.438), but patient survival after LDLT was better (P= 0.04). In Cox regression analysis, LDLT was associated with better allograft (hazards ratio [HR]= 0.7, 95% confidence interval [CI] 0.630-0.791; P < 0.0001) and patient (HR = 0.6, 95% CI 0.558-0.644; P < 0.0001) survival than DD-SLT.
  
  
  CONCLUSIONS
  Partial liver transplantation represents a potentially underutilized resource in the USA. Despite the differences in donor and recipient characteristics, LDLT is associated with better allograft and patient survival than DD-SLT. A different allocation system for DD-SLT allografts that takes into consideration cold ischaemia time and recipient MELD score should be considered.
authors: Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, USA. reza.saidi@umassmemorial.org
authors: Reza F
authors: RF
authors: Saidi
authors: Nicolas
authors: N
authors: Jabbour
authors: Youfu
authors: Y
authors: Li
authors: Shimul A
authors: SA
authors: Shah
authors: Adel
authors: A
authors: Bozorgzadeh
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D019992:Databases as Topic; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States