A national mandatory-split liver policy: A report from the Italian experience

Roberta Angelico, Silvia Trapani, Marco Spada, Michele Colledan, Jean de Ville de Goyet, Mauro Salizzoni, Luciano De Carlis, Enzo Andorno, Salvatore Gruttadauria, Giuseppe Maria Ettorre, Matteo Cescon, Giorgio Rossi, Andrea Risaliti, Giuseppe Tisone, Umberto Tedeschi, Marco Vivarelli, Salvatore Agnes, Paolo De Simone, Luigi Giovanni Lupo, Fabrizio Di BenedettoWalter Santaniello, Fausto Zamboni, Vincenzo Mazzaferro, Massimo Rossi, Francesca Puoti, Stefania Camagni, Chiara Grimaldi, Enrico Gringeri, Lucia Rizzato, Alessandro Nanni Costa, Umberto Cillo

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Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially "splittable" donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P = .009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P = .045]). The pediatric (4.5% vs 2.5% [P = .398]) and adult (9.7% to 5.2% [P < .001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P = .035) and recipient weight >20 kg (HR = 5.113, P = .048) in LLS, and ischemic time >8 hours (HR = 2.475, P = .048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

Original languageEnglish
JournalAmerican Journal of Transplantation
DOIs
Publication statusE-pub ahead of print - Feb 12 2019

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Angelico, R., Trapani, S., Spada, M., Colledan, M., de Ville de Goyet, J., Salizzoni, M., De Carlis, L., Andorno, E., Gruttadauria, S., Ettorre, G. M., Cescon, M., Rossi, G., Risaliti, A., Tisone, G., Tedeschi, U., Vivarelli, M., Agnes, S., De Simone, P., Lupo, L. G., ... Cillo, U. (2019). A national mandatory-split liver policy: A report from the Italian experience. American Journal of Transplantation. https://doi.org/10.1111/ajt.15300