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%|
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.”