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. 2000 Sep;232(3):312-23.
doi: 10.1097/00000658-200009000-00003.

Predictors of survival after In vivo split liver transplantation: analysis of 110 consecutive patients

R M Ghobrial  1 , H Yersiz, D G Farmer, F Amersi, J Goss, P Chen, S Dawson, S Lerner, N Nissen, D Imagawa, S Colquhoun, W Arnout, S V McDiarmid, R W Busuttil
Affiliations

Predictors of survival after In vivo split liver transplantation: analysis of 110 consecutive patients

R M Ghobrial et al. Ann Surg. 2000 Sep.

Abstract

Objective: To determine the factors that influence patient survival after in vivo split liver transplantation (SLT).

Summary background data: Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT.

Methods: During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT.

Results: Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 patients (49%) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables-UNOS status and number of transplants per patient-were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival.

Conclusions: Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation. in vivo SLT should be widely applied to expand a severely depleted donor pool.

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Figures

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Figure 1. Kaplan-Meier patient survival curves. Overall patient survival after split liver transplantation (♦) compared with a contemporary cohort of patients who received a whole-liver graft (▪).
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Figure 2. Kaplan-Meier survival estimates of urgent (♦) versus nonurgent (▪) recipients of split liver transplantation.
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Figure 3. Patient survival estimates according to United Network for Organ Sharing (UNOS) status before transplantation. (A) Survival of urgent (UNOS status 1 and 2A) patients after split liver (♦) versus whole-organ (▪) transplantation. (B) Survival of nonurgent (UNOS status 2, 2B, and 3) recipients after split liver (♦) versus whole-organ (▪) transplantation.
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Figure 4. Patient survival after a right (▪) or left (♦) segmental graft.
See this image and copyright information in PMC

References

    1. Starzl TE, Marchiaro TL, Von Kaulla K, et al. Homotransplantation of the liver in humans. Surg Gynecol Obstet 1963; 117: 659–676. - PMC - PubMed
    1. NIH Consensus Development Conference Statement. Liver transplantation. Hepatology 1984; 4: 1075. - PubMed
    1. Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery 1984; 95: 367–370. - PubMed
    1. Broelsch CE, Emond JC, Thistlethwaite JR, et al. Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg 1988; 208: 410–420. - PMC - PubMed
    1. Broelsch CE, Emond JC, Whitington PF, et al. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts and living related segmental transplants. Ann Surg 1990; 214: 368–370. - PMC - PubMed