Outcomes of left split graft transplantation in Europe: report from the European Liver Transplant Registry

European Liver and Intestine Transplant Association (ELITA)

Research output: Contribution to journalArticle

Abstract

Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9%) after 5 years from transplantation, 240(70.0%) occurred within the first 3 months. Estimated patient survival was 89.1% at 3 months and 82.9% at 5 years from SLT. Re-transplantation rate was 11.5%. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.

Original languageEnglish
Pages (from-to)739-750
Number of pages12
JournalTransplant International
Volume31
Issue number7
DOIs
Publication statusPublished - Jul 2018

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Registries
Transplantation
Transplants
Liver
Liver Transplantation
Cold Ischemia
Donor Selection
Tissue Donors
Pediatrics
Waiting Lists
Patient Selection
Body Weight
Guidelines
Survival
Mortality

Keywords

  • Child, Preschool
  • Europe/epidemiology
  • Female
  • Graft Survival
  • Humans
  • Infant
  • Liver Transplantation/methods
  • Male
  • Registries
  • Retrospective Studies
  • Risk Factors

Cite this

Outcomes of left split graft transplantation in Europe : report from the European Liver Transplant Registry. / European Liver and Intestine Transplant Association (ELITA).

In: Transplant International, Vol. 31, No. 7, 07.2018, p. 739-750.

Research output: Contribution to journalArticle

European Liver and Intestine Transplant Association (ELITA). / Outcomes of left split graft transplantation in Europe : report from the European Liver Transplant Registry. In: Transplant International. 2018 ; Vol. 31, No. 7. pp. 739-750.
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title = "Outcomes of left split graft transplantation in Europe: report from the European Liver Transplant Registry",
abstract = "Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9{\%}) after 5 years from transplantation, 240(70.0{\%}) occurred within the first 3 months. Estimated patient survival was 89.1{\%} at 3 months and 82.9{\%} at 5 years from SLT. Re-transplantation rate was 11.5{\%}. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.",
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author = "{European Liver and Intestine Transplant Association (ELITA)} and Roberta Angelico and Alessandra Nardi and Ren{\'e} Adam and Silvio Nadalin and Polak, {Wojciech G} and Vincent Karam and Troisi, {Roberto I} and Paolo Muiesan",
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T1 - Outcomes of left split graft transplantation in Europe

T2 - report from the European Liver Transplant Registry

AU - European Liver and Intestine Transplant Association (ELITA)

AU - Angelico, Roberta

AU - Nardi, Alessandra

AU - Adam, René

AU - Nadalin, Silvio

AU - Polak, Wojciech G

AU - Karam, Vincent

AU - Troisi, Roberto I

AU - Muiesan, Paolo

N1 - © 2018 Steunstichting ESOT.

PY - 2018/7

Y1 - 2018/7

N2 - Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9%) after 5 years from transplantation, 240(70.0%) occurred within the first 3 months. Estimated patient survival was 89.1% at 3 months and 82.9% at 5 years from SLT. Re-transplantation rate was 11.5%. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.

AB - Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9%) after 5 years from transplantation, 240(70.0%) occurred within the first 3 months. Estimated patient survival was 89.1% at 3 months and 82.9% at 5 years from SLT. Re-transplantation rate was 11.5%. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.

KW - Child, Preschool

KW - Europe/epidemiology

KW - Female

KW - Graft Survival

KW - Humans

KW - Infant

KW - Liver Transplantation/methods

KW - Male

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

U2 - 10.1111/tri.13147

DO - 10.1111/tri.13147

M3 - Article

C2 - 29505674

VL - 31

SP - 739

EP - 750

JO - Transplant International

JF - Transplant International

SN - 0934-0874

IS - 7

ER -