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 20 April 2018

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News

Split liver donation and transplants reduce pediatric mortality

The increased number of pediatric transplants due to split liver donation reduces the in-list children mortality, and decreases in the adult patient dropout rate, shows this month's issue of Liver Transplantation.

News image

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A specific split liver transplantation program has been pursued in the North Italian Transplant program since 1997.

After 5 years, 1449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors.

Dr Massimo Cardillo and colleagues from Italy performed 1126 whole liver transplantations, and 323 split liver transplantations.

Split liver transplantations were performed in situ.

Transplants due to split liver donation reduced the in-list children mortality to 3%
Liver Transplantation

These occured as 147 left lateral segments, 154 right trisegment liver grafts, and 22 modified split livers, used for couples of adult recipients.

The median posttransplant follow-up was 22 months.

The investigative team found that split liver transplantations achieved a 3-year patient and graft survival not significantly different from the entire series of transplants.

The team noted that those receiving a whole liver transplant or left lateral segments had better outcomes than with right trisegment liver and modified split livers.

At the multivariate analysis, a donor age above 60 years, right trisegment liver transplant, and less than 50 annual transplants volume were independently related to graft failure.

Urgent transplantation, ischemia time of more than 7 hours, and retransplantation were factors independently related to graft failure and to worst patient survival.

Right grafts procured from right trisegment liver, and either split procured as modified split livers had a similar outcome of marginal whole livers.

Dr Cardillo's team concludes, “In conclusion, in 5 years, the increased number of pediatric transplants due to split liver donation reduced to 3% the in-list children mortality.”

“A decrease in the adult patient dropout rate from 27% to 16% was observed.”

“Such results justify a more widespread adoption of split liver transplantations protocols, organizational difficulties not being a limit for the application of such technique.”

Liv Transplant 2006: 12(3): 402-10
08 March 2006

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