title: Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era.
abstract: OBJECTIVE
  To examine the results of split liver transplantation for 2 adults in the model of end-stage liver disease (MELD) era.
  
  
  BACKGROUND
  In the MELD era, liver allografts are first allocated to recipients with the highest MELD scores. However, the application of split liver transplantation for 2 adults in urgent condition has doubled and has become a matter of concern.
  
  
  METHODS
  Twenty-one deceased liver grafts were split into full right and full left lobes for 42 adult recipients. One of the hemiliver grafts was allocated to the recipient with the highest MELD score in the waiting list. The results of split liver transplantation were examined and compared with those of living donor liver transplantation.
  
  
  RESULTS
  Among 42 recipients, 24 (57.1%) had MELD scores higher than 20. The median (interquartile) MELD score for the recipients with split liver transplantation was 22 (15-30), which was higher than that for the recipients with living donor liver transplantation (P < 0.001). The 1-, 3-, and 5-year survival rates for split liver transplantation were comparable with those of living donor transplantation (P = 0.489). Nevertheless, 10 of 42 split liver recipients died within 3 months after transplantation. By receiver operating characteristic curve analysis, the safe graft-recipient weight ratio was better more than 1% to avoid early patient death for split liver transplantation.
  
  
  CONCLUSIONS
  Although most of the recipients with split liver transplantation had high MELD scores, the results were comparable with those of living donor liver transplantation. Split liver transplantation for 2 adults is still feasible in the MELD era.
authors.affiliation: Department of Liver and Transplantation Surgery, Chang-Gung Transplantation Institute, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan. weichen@cgmh.org.tw
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
authors.forename: Kun-Ming
authors.initials: KM
authors.lastname: Chan
authors.forename: Hong-Shiue
authors.initials: HS
authors.lastname: Chou
authors.forename: Ting-Jung
authors.initials: TJ
authors.lastname: Wu
authors.forename: Chen-Fang
authors.initials: CF
authors.lastname: Lee
authors.forename: Ruey-Shyang
authors.initials: RS
authors.lastname: Soong
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Wu
authors.forename: Ching-Song
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012372:ROC Curve; D012720:Severity of Illness Index; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult