A prospective policy development to increase split-liver transplantation for 2 adult recipients

Results of a 12-year multicenter collaborative study

Paolo Aseni, Tullia Maria De Feo, Luciano De Carlis, Umberto Valente, Michele Colledan, Umberto Cillo, Giorgio Rossi, Vincenzo Mazzaferro, Matteo Donataccio, Nicola De Fazio, Enzo Andorno, Patrizia Burra, Alessandro Giacomoni, Abdallah Omar Slim, Carlo Sposito, Andrea De Gasperi, Barbara Antonelli, Giacomo Zanus, Domenico Pinelli, Marco Zambelli & 5 others Nicola Morelli, Roberto Valente, Gaetano Grosso, Martina Mantovani, Giuseppe Piccolo

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

Original languageEnglish
Pages (from-to)157-165
Number of pages9
JournalAnnals of Surgery
Volume259
Issue number1
DOIs
Publication statusPublished - Jan 2014

Fingerprint

Policy Making
Liver Transplantation
Multicenter Studies
Transplants
Liver
Tissue Donors
Child Mortality
Multivariate Analysis
Survival Rate
Pediatrics

Keywords

  • Liver transplantation
  • Segmental liver transplantation
  • Split-liver transplantation
  • Surgical complications
  • Surgical technique

ASJC Scopus subject areas

  • Surgery

Cite this

A prospective policy development to increase split-liver transplantation for 2 adult recipients : Results of a 12-year multicenter collaborative study. / Aseni, Paolo; De Feo, Tullia Maria; De Carlis, Luciano; Valente, Umberto; Colledan, Michele; Cillo, Umberto; Rossi, Giorgio; Mazzaferro, Vincenzo; Donataccio, Matteo; De Fazio, Nicola; Andorno, Enzo; Burra, Patrizia; Giacomoni, Alessandro; Slim, Abdallah Omar; Sposito, Carlo; De Gasperi, Andrea; Antonelli, Barbara; Zanus, Giacomo; Pinelli, Domenico; Zambelli, Marco; Morelli, Nicola; Valente, Roberto; Grosso, Gaetano; Mantovani, Martina; Piccolo, Giuseppe.

In: Annals of Surgery, Vol. 259, No. 1, 01.2014, p. 157-165.

Research output: Contribution to journalArticle

Aseni, P, De Feo, TM, De Carlis, L, Valente, U, Colledan, M, Cillo, U, Rossi, G, Mazzaferro, V, Donataccio, M, De Fazio, N, Andorno, E, Burra, P, Giacomoni, A, Slim, AO, Sposito, C, De Gasperi, A, Antonelli, B, Zanus, G, Pinelli, D, Zambelli, M, Morelli, N, Valente, R, Grosso, G, Mantovani, M & Piccolo, G 2014, 'A prospective policy development to increase split-liver transplantation for 2 adult recipients: Results of a 12-year multicenter collaborative study', Annals of Surgery, vol. 259, no. 1, pp. 157-165. https://doi.org/10.1097/SLA.0b013e31827da6c9
Aseni, Paolo ; De Feo, Tullia Maria ; De Carlis, Luciano ; Valente, Umberto ; Colledan, Michele ; Cillo, Umberto ; Rossi, Giorgio ; Mazzaferro, Vincenzo ; Donataccio, Matteo ; De Fazio, Nicola ; Andorno, Enzo ; Burra, Patrizia ; Giacomoni, Alessandro ; Slim, Abdallah Omar ; Sposito, Carlo ; De Gasperi, Andrea ; Antonelli, Barbara ; Zanus, Giacomo ; Pinelli, Domenico ; Zambelli, Marco ; Morelli, Nicola ; Valente, Roberto ; Grosso, Gaetano ; Mantovani, Martina ; Piccolo, Giuseppe. / A prospective policy development to increase split-liver transplantation for 2 adult recipients : Results of a 12-year multicenter collaborative study. In: Annals of Surgery. 2014 ; Vol. 259, No. 1. pp. 157-165.
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T1 - A prospective policy development to increase split-liver transplantation for 2 adult recipients

T2 - Results of a 12-year multicenter collaborative study

AU - Aseni, Paolo

AU - De Feo, Tullia Maria

AU - De Carlis, Luciano

AU - Valente, Umberto

AU - Colledan, Michele

AU - Cillo, Umberto

AU - Rossi, Giorgio

AU - Mazzaferro, Vincenzo

AU - Donataccio, Matteo

AU - De Fazio, Nicola

AU - Andorno, Enzo

AU - Burra, Patrizia

AU - Giacomoni, Alessandro

AU - Slim, Abdallah Omar

AU - Sposito, Carlo

AU - De Gasperi, Andrea

AU - Antonelli, Barbara

AU - Zanus, Giacomo

AU - Pinelli, Domenico

AU - Zambelli, Marco

AU - Morelli, Nicola

AU - Valente, Roberto

AU - Grosso, Gaetano

AU - Mantovani, Martina

AU - Piccolo, Giuseppe

PY - 2014/1

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N2 - OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

AB - OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

KW - Liver transplantation

KW - Segmental liver transplantation

KW - Split-liver transplantation

KW - Surgical complications

KW - Surgical technique

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