title: Intention to Split Policy: A Successful Strategy in a Combined Pediatric and Adult Liver Transplant Center.
abstract: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an "intention to split policy."
  
  
  
  SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.
  
  
  
  Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.
  
  
  
  Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of "intention to split policy" resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.
  
  
  
  SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.
authors.affiliation: *Liver Unit, Queen Elizabeth University Hospital, Edgbaston, Birmingham, United Kingdom †Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, United Kingdom.
authors.forename: Narendra R
authors.initials: NR
authors.lastname: Battula
authors.forename: Marco
authors.initials: M
authors.lastname: Platto
authors.forename: Ravindar
authors.initials: R
authors.lastname: Anbarasan
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ong
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Roll
authors.forename: Ben-Hur
authors.initials: BH
authors.lastname: Ferraz Neto
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Khalid
authors.initials: K
authors.lastname: Sharif
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D006084:Graft Rejection; D006085:Graft Survival; D006291:Health Policy; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D011050:Policy Making; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome; D006113:United Kingdom; D014850:Waiting Lists