title: Fifteen years and 382 extended right grafts from in situ split livers in a multicenter study: Are these still extended criteria liver grafts?
abstract: In situ split liver extended right grafts (SL-ERGs) are still considered marginal grafts. Our aim was to verify this statement at the present time. From 1997 to 2011, a multicenter, retrospective study based on a prospective database was performed at 9 liver transplantation (LT) centers in northern Italy; it included 382 in situ SL-ERG transplants in adults. There were 358 primary LTs and 24 retransplantations (RETXs). The 1-, 3-, and 5-year overall graft survival rate for LT with in situ SL-ERGs were 73.5%, 63.3%, and 60.7%, respectively, from 1997 to 2004 and 83.5%, 80.3%, and 80.3%, respectively, thereafter (P=0.0001). A shorter total ischemia time and fewer RETX grafts were the main differences between the characteristics of the 2 periods. From 1997 to 2011, the 1-, 3-, and 5-year graft survival rates showed a significant difference between the 358 primary LT in situ SL-ERGs and the 24 RETX in situ SL-ERGs (P<0.001). In a multivariate analysis, the main prognostic factor for 60-day graft survival was a total ischemia time<8 hours for the 358 primary in situ SL-ERGs. From 2005 to 2011, in 2473 LTs, the 5-year graft survival for 184 in situ SL-ERGs and 2289 whole grafts was 75% and 80% (P=0.3), respectively. Univariate and multivariate studies alike failed to indicate that the type of graft was a prognostic factor for graft survival. A donor age>60 years, RETX grafts, and urgency were the main prognostic factors for failure for all of the grafts. Although caution should be taken regarding the choice of appropriate donors, in situ SL-ERGs should no longer be considered marginal grafts for experienced LT centers. SL-ERGs should not be used in RETX settings, and when SL-ERGs are used as primary grafts, the total ischemia time should be less than 8 hours.
authors.affiliation: UO Chirurgia Generale e Trapianti di Fegato, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Digestive and Hepatobiliary Surgery, AP-HP, U.F.R. de Médecine de l'Université Paris XII-Créteil, Paris, France.
authors.forename: Umberto
authors.initials: U
authors.lastname: Maggi
authors.forename: Tullia M
authors.initials: TM
authors.lastname: De Feo
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Nicola
authors.initials: N
authors.lastname: De Fazio
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002983:Clinical Competence; D050377:Cold Ischemia / Q000009:adverse effects; D003661:Decision Support Techniques; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult