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A Prospective Policy Development to Increase Split-Liver Transplantation for 2 Adult Recipients: Results of a 12-Year Multicenter Collaborative Study

Aseni, Paolo MD*; De Feo, Tullia Maria MD; De Carlis, Luciano MD*; Valente, Umberto MD; Colledan, Michele MD, FEBS§; Cillo, Umberto MD, FEBS; Rossi, Giorgio MD; Mazzaferro, Vincenzo MD**; Donataccio, Matteo MD††; De Fazio, Nicola PhD; Andorno, Enzo MD; Burra, Patrizia MD,‡‡; on behalf of the Split-Liver Study Group

Annals of Surgery:
doi: 10.1097/SLA.0b013e31827da6c9
Original Articles
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.

In Brief

In this prospective study, 64 adult patients received a partial liver graft after adult-to-adult split-liver procedure from 35 donors. The outcomes of these patients when compared with a matched cohort of patients receiving a conventional whole liver transplant showed a high rate of postoperative complications and a lower 5-year survival rate.

Author Information

*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.

Reprints: Paolo Aseni, MD, Department of General Surgery and Transplantation, Ospedale Niguarda, Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy. E-mail: paoloaseni@gmail.com.

Members of the Split-Liver Study Group who participated to the study as clinical investigators are as follows: Alessandro Giacomoni, MD, Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda Hospital, Milan, Italy; Abdallah Omar Slim, MD, Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda Hospital, Milan, Italy; Carlo Sposito, MD, Unit of Gastrointestinal Surgery and Liver Transplantation, National Cancer Institute of Milan, Milan, Italy; Andrea De Gasperi, MD, Anesthesia and Intensive Care Unit, Transplantation Department, Ospedale Niguarda Ca' Granda, Milan, Italy, Barbara Antonelli, MD, Liver Transplant Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan, Italy; Giacomo Zanus, MD, Department of General and Transplantation Surgery, University of Padua, Italy; Domenico Pinelli, MD, Chirurgia III, Centro trapianto di fegato e di intestino Ospedali Riuniti di Bergamo, Italy; Marco Zambelli, MD, Chirurgia III, Centro trapianto di fegato e di intestino Ospedali Riuniti di Bergamo, Italy; Nicola Morelli, MD, Department of Transplant Surgery, Ospedale San Martino, University of Genoa, Genoa, Italy; Roberto Valente, MD, Department of Transplant Surgery, Ospedale San Martino, University of Genoa, Genoa, Italy; Gaetano Grosso, MD, Liver Transplantation Unit, Ospedale Civile Maggiore, Verona, Italy. Martina Mantovani, MD, Organ and Tissue Transplant Immunology Unit, IRCCS Ospedale Maggiore, Milan, Italy; Giuseppe Piccolo, MD, Organ and Tissue Transplant Immunology Unit, IRCCS Ospedale Maggiore, Milan, Italy.

Disclosure: The authors declare no conflicts of interest.

The program was approved and supported by the Italian Ministry of Health.

© 2014 by Lippincott Williams & Wilkins.