Split liver transplantation has been proposed as an alternative to whole liver transplantation to expand the donor pool, but studies comparing adult long-term outcomes between the two methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts for long-term survival outcomes. In the overall population, whole liver recipients showed higher patient survival at one- (93% vs. 73%), five- (87% vs. 65%) and ten-year (83% vs. 60%) after transplantation compared to split liver recipients (p<0.001); graft survivals of whole liver recipients were also superior at one- (90% vs. 76%), five- (84% vs. 57%) and ten-year (81% vs. 52%) post-transplant (p < 0.001). However, among the 81 matched-pairs that survived the first post-transplant year, five- and ten-year patient survivals were 90% and 81% for split recipients and 99% and 96% for whole recipients, respectively (p = 0.34). Five- and ten-year graft survivals were also comparable: 87% and 77% for split recipients, and 86% and 82% for whole recipients (p = 0.86). Cox regression analysis identified donor age >50, donor-to-recipient weight ratio <1, re-transplantation status and UNOS I-IIA status as risk factors for partial graft use. There were no significant differences in five-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with extended right grafts can achieve long-term success comparable to that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. This article is protected by copyright. All rights reserved.

A Matched Pair Analysis of Multicenter Long-term Follow-up after Split Liver Transplantation with Extended Right Grafts

BACCARANI, Umberto;
2017-01-01

Abstract

Split liver transplantation has been proposed as an alternative to whole liver transplantation to expand the donor pool, but studies comparing adult long-term outcomes between the two methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts for long-term survival outcomes. In the overall population, whole liver recipients showed higher patient survival at one- (93% vs. 73%), five- (87% vs. 65%) and ten-year (83% vs. 60%) after transplantation compared to split liver recipients (p<0.001); graft survivals of whole liver recipients were also superior at one- (90% vs. 76%), five- (84% vs. 57%) and ten-year (81% vs. 52%) post-transplant (p < 0.001). However, among the 81 matched-pairs that survived the first post-transplant year, five- and ten-year patient survivals were 90% and 81% for split recipients and 99% and 96% for whole recipients, respectively (p = 0.34). Five- and ten-year graft survivals were also comparable: 87% and 77% for split recipients, and 86% and 82% for whole recipients (p = 0.86). Cox regression analysis identified donor age >50, donor-to-recipient weight ratio <1, re-transplantation status and UNOS I-IIA status as risk factors for partial graft use. There were no significant differences in five-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with extended right grafts can achieve long-term success comparable to that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. This article is protected by copyright. All rights reserved.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11390/1114608
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