Putative survival predictors in right-graft (adult) recipients after in situ split-liver transplantation: A retrospective single-center analysis

In situ split-liver transplantation (isSLT) is an innovative surgical technique that is effective in expanding the cadaveric organ pool. Through isSLT, the bipartition of a single liver provides a right graft for an adult recipient (75% of the total liver volume, comparable to a normal whole liver of smaller size) and a left lateral graft for a pediatric recipient. In the present study we investigated the potential predictive value of donor and patient characteristics for 1-year survival, early postoperative graft function markers, and hemostatic parameters in 24 adult recipients that underwent isSLT, and we compared this cohort with a group of 29 whole-liver recipients. An overall coagulation abnormality score (CAS) that we derived by assigning one point for each abnormality in the hemostatic tests was also calculated. Through univariate comparison, the age of donor and patient was significantly associated with poor survival after isSLT, though not in the case of whole-liver transplantation. In a multivariate logistic regression model that we fitted for 1-year survival of right-graft recipients by entering donor and patient age, only the latter showed statistical significance (P = 0.04). Among early postoperative graft function markers and hemostatic parameters, a platelet count of ≤ 50×10⁹/1 and a CAS of > 2 on day 8 after isSLT indicated a reduced survival rate after isSLT. A CAS of > 2 on day 8 was predictive for 1-year survival in whole-liver recipients as well. Multivariate Cox regression analysis identified the CAS as an independent predictor of survival (P = 0.0214) in right-graft recipients. This study suggests that early postoperative CAS calculation may be a putative survival predictor in right-graft recipients after isSLT.