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

Research output: Contribution to journalArticle

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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Liver Transplantation
Liver
Tissue Donors
Waiting Lists
Pediatrics
Transplants
Patient Selection
Italy

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A national mandatory-split liver policy : A report from the Italian experience. / Angelico, Roberta; Trapani, Silvia; Spada, Marco; Colledan, Michele; de Ville de Goyet, Jean; Salizzoni, Mauro; De Carlis, Luciano; Andorno, Enzo; Gruttadauria, Salvatore; Ettorre, Giuseppe Maria; Cescon, Matteo; Rossi, Giorgio; Risaliti, Andrea; Tisone, Giuseppe; Tedeschi, Umberto; Vivarelli, Marco; Agnes, Salvatore; De Simone, Paolo; Lupo, Luigi Giovanni; Di Benedetto, Fabrizio; Santaniello, Walter; Zamboni, Fausto; Mazzaferro, Vincenzo; Rossi, Massimo; Puoti, Francesca; Camagni, Stefania; Grimaldi, Chiara; Gringeri, Enrico; Rizzato, Lucia; Nanni Costa, Alessandro; Cillo, Umberto.

In: American Journal of Transplantation, 12.02.2019.

Research output: Contribution to journalArticle

Angelico, R, Trapani, S, Spada, M, Colledan, M, de Ville de Goyet, J, Salizzoni, M, De Carlis, L, Andorno, E, Gruttadauria, S, Ettorre, GM, Cescon, M, Rossi, G, Risaliti, A, Tisone, G, Tedeschi, U, Vivarelli, M, Agnes, S, De Simone, P, Lupo, LG, Di Benedetto, F, Santaniello, W, Zamboni, F, Mazzaferro, V, Rossi, M, Puoti, F, Camagni, S, Grimaldi, C, Gringeri, E, Rizzato, L, Nanni Costa, A & 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
Angelico, Roberta ; Trapani, Silvia ; Spada, Marco ; Colledan, Michele ; de Ville de Goyet, Jean ; Salizzoni, Mauro ; De Carlis, Luciano ; Andorno, Enzo ; Gruttadauria, Salvatore ; Ettorre, Giuseppe Maria ; Cescon, Matteo ; Rossi, Giorgio ; Risaliti, Andrea ; Tisone, Giuseppe ; Tedeschi, Umberto ; Vivarelli, Marco ; Agnes, Salvatore ; De Simone, Paolo ; Lupo, Luigi Giovanni ; Di Benedetto, Fabrizio ; Santaniello, Walter ; Zamboni, Fausto ; Mazzaferro, Vincenzo ; Rossi, Massimo ; Puoti, Francesca ; Camagni, Stefania ; Grimaldi, Chiara ; Gringeri, Enrico ; Rizzato, Lucia ; Nanni Costa, Alessandro ; Cillo, Umberto. / A national mandatory-split liver policy : A report from the Italian experience. In: American Journal of Transplantation. 2019.
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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.",
author = "Roberta Angelico and Silvia Trapani and Marco Spada and Michele Colledan and {de Ville de Goyet}, Jean and Mauro Salizzoni and {De Carlis}, Luciano and Enzo Andorno and Salvatore Gruttadauria and Ettorre, {Giuseppe Maria} and Matteo Cescon and Giorgio Rossi and Andrea Risaliti and Giuseppe Tisone and Umberto Tedeschi and Marco Vivarelli and Salvatore Agnes and {De Simone}, Paolo and Lupo, {Luigi Giovanni} and {Di Benedetto}, Fabrizio and Walter Santaniello and Fausto Zamboni and Vincenzo Mazzaferro and Massimo Rossi and Francesca Puoti and Stefania Camagni and Chiara Grimaldi and Enrico Gringeri and Lucia Rizzato and {Nanni Costa}, Alessandro and Umberto Cillo",
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T1 - A national mandatory-split liver policy

T2 - A report from the Italian experience

AU - Angelico, Roberta

AU - Trapani, Silvia

AU - Spada, Marco

AU - Colledan, Michele

AU - de Ville de Goyet, Jean

AU - Salizzoni, Mauro

AU - De Carlis, Luciano

AU - Andorno, Enzo

AU - Gruttadauria, Salvatore

AU - Ettorre, Giuseppe Maria

AU - Cescon, Matteo

AU - Rossi, Giorgio

AU - Risaliti, Andrea

AU - Tisone, Giuseppe

AU - Tedeschi, Umberto

AU - Vivarelli, Marco

AU - Agnes, Salvatore

AU - De Simone, Paolo

AU - Lupo, Luigi Giovanni

AU - Di Benedetto, Fabrizio

AU - Santaniello, Walter

AU - Zamboni, Fausto

AU - Mazzaferro, Vincenzo

AU - Rossi, Massimo

AU - Puoti, Francesca

AU - Camagni, Stefania

AU - Grimaldi, Chiara

AU - Gringeri, Enrico

AU - Rizzato, Lucia

AU - Nanni Costa, Alessandro

AU - Cillo, Umberto

N1 - © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.

PY - 2019/2/12

Y1 - 2019/2/12

N2 - 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.

AB - 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.

U2 - 10.1111/ajt.15300

DO - 10.1111/ajt.15300

M3 - Article

C2 - 30748091

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

ER -