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

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.