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. 2013 Oct;217(4):672-684.e1.
doi: 10.1016/j.jamcollsurg.2013.06.005. Epub 2013 Aug 23.

Deceased-donor split-liver transplantation in adult recipients: is the learning curve over?

Ryan P Cauley  1 , Khashayar Vakili, Nora Fullington, Kristina Potanos, Dionne A Graham, Jonathan A Finkelstein, Heung Bae Kim
Affiliations

Deceased-donor split-liver transplantation in adult recipients: is the learning curve over?

Ryan P Cauley et al. J Am Coll Surg. 2013 Oct.

Abstract

Background: Infants have the highest wait-list mortality of all liver transplantation candidates. Deceased-donor split-liver transplantation, a technique that provides both an adult and pediatric graft, might be the best way to decrease this disproportionate mortality. Yet concern for an increased risk to adult split recipients has discouraged its widespread adoption. We aimed to determine the current risk of graft failure in adult recipients after split-liver transplantation.

Study design: United Network for Organ Sharing data from 62,190 first-time adult recipients of deceased-donor liver transplants (1995-2010) were analyzed (889 split grafts). Bivariate risk factors (p < 0.2) were included in Cox proportional hazards models of the effect of transplant type on graft failure.

Results: Split-liver recipients had an overall hazard ratio of graft failure of 1.26 (p < 0.001) compared with whole-liver recipients. The split-liver hazard ratio was 1.45 (p < 0.001) in the pre-Model for End-Stage Liver Disease era (1995-2002) and 1.10 (p = 0.28) in the Model for End-Stage Liver Disease era (2002-2010). Interaction analyses suggested an increased risk of split-graft failure in status 1 recipients and those given an exception for hepatocellular carcinoma. Excluding higher-risk recipients, split and whole grafts had similar outcomes (hazard ratio = 0.94; p = 0.59).

Conclusions: The risk of graft failure is now similar between split and whole-liver recipients in the vast majority of cases, which demonstrates that the expansion of split-liver allocation might be possible without increasing the overall risk of long-term graft failure in adult recipients. Additional prospective analysis should examine if selection bias might account for the possible increase in risk for recipients with hepatocellular carcinoma or designated status 1.

Keywords: DD; HCC; LD; MELD; Model for End-Stage Liver Disease; UNOS; United Network for Organ Sharing; deceased donor; hepatocellular carcinoma; living donor.

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Conflict of interest statement

Disclosures:

The authors of this manuscript are not supported by any commercial associations and have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. (A–H). Unadjusted Analysis
Kaplan Meier curves of graft survival in split and whole liver transplantation. (A) All donors (1995–2010). (B) Donor Age Restricted (Only Donors ≤ 40 years, 1995–2010). (C) Effect of MELD on Transplant Type, (Donors ≤ 40 years, 1995–2010). (D) Split Type in Pre-MELD era (Donors ≤ 40 years, 1995–1/2002). (E) Split Type in Post-MELD era (Donors ≤ 40 years, 2/2002–2010). (F) Effect of Status 1 on Transplant Type (Donors ≤ 40 years, 1995–2010). (G) Effect of HCC Exception on Transplant Type (Donors ≤ 40 years, 2002–2010). (H) Excluding recipients with the HCC Exception and Status 1 Donors ≤ 40 years, 2002–2010).
See this image and copyright information in PMC

References

    1. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) OPTN / SRTR 2007 Annual Data Report. Available at: http://www.srtr.org/annual_reports/
    1. Magee JC, Krishnan SM, Benfield MR, Hsu DT, Shneider BL. Pediatric transplantation in the United States, 1997–2006. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2008 Apr;8(4 Pt 2):935–945. - PubMed
    1. Kim WR, Stock PG, Smith JM, et al. OPTN/SRTR 2011 Annual Data Report: liver. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2013 Jan;13(Suppl 1):73–102. - PubMed
    1. Ng VL, Alonso EM, Bucuvalas JC, et al. Health Status of Children Alive 10 Years after Pediatric Liver Transplantation Performed in the US and Canada: Report of the Studies of Pediatric Liver Transplantation Experience. The Journal of pediatrics. 2011 Dec 20; - PMC - PubMed
    1. Horslen S, Barr ML, Christensen LL, Ettenger R, Magee JC. Pediatric transplantation in the United States, 1996–2005. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2007;7(5 Pt 2):1339–1358. - PubMed

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