Split and whole liver transplantation outcomes: A comparative cohort study

Massimo Cardillo, Nicola De Fazio, Paola Pedotti, Tullia De Feo, Luigi Rainero Fassati, Vincenzo Mazzaferro, Michele Colledan, Bruno Gridelli, Lucio Caccamo, Luciano DeCarlis, Umberto Valente, Enzo Andorno, Mariangelo Cossolini, Cristiano Martini, Adelmo Antonucci, Umberto Cillo, Giacomo Zanus, Umberto Baccarani, Mario Scalamogna

Research output: Contribution to journalArticle

Abstract

A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1, 126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow-up of 22 months, SLTs; achieved a 3-yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P <0.03 for patients and P <0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, 7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in-list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique.

Original languageEnglish
Pages (from-to)402-410
Number of pages9
JournalLiver Transplantation
Volume12
Issue number3
DOIs
Publication statusPublished - Mar 2006

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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    Cardillo, M., De Fazio, N., Pedotti, P., De Feo, T., Fassati, L. R., Mazzaferro, V., Colledan, M., Gridelli, B., Caccamo, L., DeCarlis, L., Valente, U., Andorno, E., Cossolini, M., Martini, C., Antonucci, A., Cillo, U., Zanus, G., Baccarani, U., & Scalamogna, M. (2006). Split and whole liver transplantation outcomes: A comparative cohort study. Liver Transplantation, 12(3), 402-410. https://doi.org/10.1002/lt.20720