Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease

Bruno Gridelli, Marco Spada, Wanda Petz, Alessandro Bertani, Alessandro Lucianetti, Michele Colledan, Monica Altobelli, Daniele Alberti, Michela Guizzetti, Silvia Riva, Maria L. Melzi, Paola Stroppa, Giuliano Torre

Research output: Contribution to journalArticlepeer-review

Abstract

Background. End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT). Methods. Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8). Results. Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively. Conclusions. SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.

Original languageEnglish
Pages (from-to)1197-1203
Number of pages7
JournalTransplantation
Volume75
Issue number8
DOIs
Publication statusPublished - Apr 27 2003

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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