Annals of Surgery

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

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

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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.

© 2014 by Lippincott Williams & Wilkins.


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