Cadaveric full-size liver transplantation and the graft alternatives in adults: A comparative study from a single centre

Sebagh, Mylène; Yılmaz, Funda; Karam, Vincent; Falissard, Bruno; Ichaı̈, Philippe; Roche, Bruno; Castaing, Denis; Guettier, Catherine; Samuel, Didier; Azoulay, Daniel

doi:10.1016/j.jhep.2005.07.029

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…Furthermore, the short-and long-term complication rates were not significantly different between both transplant procedures. Other comparing studies showed a similar [31][32][33] or slightly inferior 25,34 outcome of split compared with whole liver grafts (Table 2). A more recently published study comes from the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) database.…”

Section: Results and Outcomementioning

confidence: 81%

Evolving Surgical Approaches in Liver Transplantation

Petrowsky

Busuttil²

2009

Semin Liver Dis

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The growing discrepancy between the need and the availability of donor livers has resulted in evolving surgical approaches in liver transplantation during the last two decades to expand the donor pool. One approach is to transplant partial grafts, obtained either from a living donor or splitting a cadaveric donor liver. For both surgical methods, it is important to obtain a minimal viable graft volume to prevent small-for-size syndrome and graft failure. This minimal volume, expressed as graft-to-whole body ratio, must be between 0.8 and 1%. Living donor liver transplantation (LDLT) became the primary transplant option in many Asian countries and is increasingly performed as an adjunct transplant option in countries with low donation rates. Split liver transplantation (SLT) is a surgical method that creates two allografts from one deceased donor. The most widely used splitting technique is the division of the liver into a left lateral sectoral graft (segments 2 and 3) for a pediatric patient and a right trisegmental graft (segments 1 and 4 to 8) for an adult patient. Both LDLT and SLT are also important and established methods for the treatment of pediatric patients. Another evolving surgical approach is auxiliary liver transplantation, which describes the transplanting a whole or partial graft with preservation of the partial native liver. This bridging technique is applied in patients with fulminate liver failure and should allow the regeneration of the injured liver with the potential to discontinue immunosuppression. Other methods such as xenotransplantation, as well as hepatocyte and stem cell transplantation, are promising approaches that are still in experimental phases.

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Section: Results and Outcomementioning

confidence: 81%

Evolving Surgical Approaches in Liver Transplantation

Petrowsky

Busuttil²

2009

Semin Liver Dis

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“…Among nine recent comparative studies of SLT and WLT showing similar results for both procedures [4,14,21,[23][24][25][26][27][28] only Bonney et al [21] from Leeds reported for the first time the outcomes of a matched pair analysis using the MELD score for matching extended right SLT (n = 27) and WLT (n = 27) recipients. Interestingly, the mean MELD score was 16 in both groups (i.e.…”

Section: Discussionmentioning

confidence: 99%

Split-liver transplantation in the high-MELD adult patient: are we being too cautious?

Nadalin

Schaffer

Fruehauf

2009

Transplant International

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Summary The fear that patients with high‐mathematical model for end stage liver disease (MELD) score may not be suitable candidates for segmental grafts because of their need for greater liver mass has continued to push the transplant community toward the use of whole LT (WLT) in preference to split LT (SLT). In order to define the outcome of segmental liver transplantation in a better manner in high‐MELD patients (score ≥26), we queried the UNOS registry for graft and patient survival results according to MELD score in adult patients receiving WLT and SLT in the United States from the inception of MELD allocation (February 27, 2002) through March 9, 2007. A total of 316 adult patients received a SLT as compared with 20 778 WLTs. Patient and graft survival rates at 6 and 12 months were comparable for all MELD ranges, including the ‘high‐MELD’ recipients (e.g. at MELD score 31–35, patients’ and grafts’ survival rates at 12 months was 87.5% in SLT group vs. 84.4% and 76.7% in WLT group respectively). The results even at higher MELD scores (i.e. >35) were more than acceptable. In conclusion, patient and graft survival rates for SLT in high‐MELD adult patients are comparable to the same for WLT.

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“…In a large retrospective study of patients undergoing LT for hepatocellular carcinoma (HCC), the incidence of major complications was higher among patients receiving DLT explants than among patients receiving DDLT, although patient survival was similar between the two groups . Another single‐center analysis and several case reports have reported successful outcomes of patients receiving a DLT explant for a wide range of patient demographics and indications for LT .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of domino liver transplantation compared to deceased donor liver transplantation: a propensity-matching approach

et al. 2018

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Domino liver transplantation (DLT) utilizes the explanted liver of one liver transplant recipient as a donor graft in another patient. While there may be unique risks associated with DLT, it is unclear if DLT has less favorable long-term outcomes than deceased donor liver transplantation (DDLT). We used a propensity score matching approach to compare the outcomes of DLT recipients to DDLT recipients. The United Network for Organ Sharing (UNOS) registry was queried for patients undergoing DLT or DDLT in 2002-2016. Each DLT recipient was matched to a unique DDLT recipient to compare mortality and graft failure. There were 126 DLT and 62 835 DDLT recipients meeting inclusion criteria. After propensity score matching on recipient pre-transplant characteristics, 123 DLT cases were matched to DDLT controls from the same UNOS region. On stratified Cox proportional hazards regression, DLT incurred no increase in the hazard of mortality [hazard ratio (HR) = 1.4; 95% confidence interval (CI): 0.8, 2.7; P = 0.265] or graft failure (HR = 1.2; 95% CI: 0.7, 2.1; P = 0.556) compared to DDLT. Using a large national registry, a propensity-matched analysis found no increased risk of mortality or graft failure associated with DLT compared to DDLT.

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Cadaveric full-size liver transplantation and the graft alternatives in adults: A comparative study from a single centre

Cited by 22 publications

References 26 publications

Evolving Surgical Approaches in Liver Transplantation

Evolving Surgical Approaches in Liver Transplantation

Split-liver transplantation in the high-MELD adult patient: are we being too cautious?

Outcomes of domino liver transplantation compared to deceased donor liver transplantation: a propensity-matching approach

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