title: A prospective policy development to increase split-liver transplantation for 2 adult recipients: results of a 12-year multicenter collaborative study.
abstract: OBJECTIVE
  To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients.
  
  
  BACKGROUND
  Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated.
  
  
  METHODS
  We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome.
  
  
  RESULTS
  Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%)
  
  
  CONCLUSIONS
  AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.
authors: *Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda Hospital, Milan †Organ and Tissue Transplant Immunology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan ‡Department of Transplant Surgery, Ospedale San Martino, University of Genoa, Genoa §Chirurgia III, Centro trapianto di fegato e di intestino Ospedali Riuniti di Bergamo ¶Hepato-biliary Surgery and Liver Transplantation Unit, University of Padua, Padua ‖Liver Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan **Unit of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Milan ††Liver Transplantation Unit, Azienda Ospedaliera-Universitaria Verona ‡‡Department of Surgical and Gastroenterological Sciences, University of Padua, Padua.
authors: Paolo
authors: P
authors: Aseni
authors: Tullia Maria
authors: TM
authors: De Feo
authors: Luciano
authors: L
authors: De Carlis
authors: Umberto
authors: U
authors: Valente
authors: Michele
authors: M
authors: Colledan
authors: Umberto
authors: U
authors: Cillo
authors: Giorgio
authors: G
authors: Rossi
authors: Vincenzo
authors: V
authors: Mazzaferro
authors: Matteo
authors: M
authors: Donataccio
authors: Nicola
authors: N
authors: De Fazio
authors: Enzo
authors: E
authors: Andorno
authors: Patrizia
authors: P
authors: Burra
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D019737:Transplants / Q000600:supply & distribution; D055815:Young Adult