Donor and recipient selection leads to good patient and graft outcomes for right lobe split transplantation versus whole graft liver transplantation in adult recipients

Sandroussi, Charbel; Crawford, Michael; Lockwood, David; Tang, Patrick; Gallagher, James; Pleass, Henry; Strasser, Simone I.; Shackel, Nicholas; McCaughan, Geoffrey W.; Verran, Deborah

doi:10.1002/lt.21849

Cited by 24 publications

(29 citation statements)

References 20 publications

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“…Rates of vascular complications in adults vary in the literature between 2% and 11.6% for hepatic artery thrombosis and 0%‐2.3% for portal vein thrombosis . Doyle et al.…”

Section: Discussionmentioning

confidence: 99%

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Moussaoui

Toso

Nowacka

et al. 2017

Pediatric Transplantation

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Split-liver transplantation (LT) allows transplantation of two recipients from one deceased donor, thereby increasing pool of grafts. However, split LT may be hampered by technical problems, and split grafts are still considered suboptimal organs in some centres. We analysed the outcomes in split- and whole-liver recipients in a combined adult-to-paediatric transplantation programme. Records of paediatric and adult patients having undergone LT from 1999 to 2013 were analysed retrospectively. All splits were performed in situ. Adult split-graft recipients were matched 1:2 with whole-graft recipients (matching criteria: BMI, MELD, year of transplantation, age), and matched to the paediatric recipient transplanted from the same donor. Post-LT complications were classified according to the Clavien scale. Among children, 32 split- and 31 whole-graft recipients were analysed. Among adults, 20 split- and 40 matched whole-graft recipients were analysed. In both populations, the post-operative complications did not differ between split- and whole-graft recipients. There was no difference in 1-year graft and patient survival between split- and whole-graft recipients in paediatric (90% vs. 97%, 94% vs. 97%, respectively) and in adult recipients (89% in both, 89% vs. 92%, respectively). In the analysis of both recipients issued from the same donor, there was no association in the prevalence and severity of complications. A case-by-case analysis showed that split mortality was unrelated to LT in all but one patient (small-for-size left split graft). In the setting of careful donor selection, recipient matching and surgical skill, in situ split LT is an effective and safe technique to increase the number of available organs, and split livers should no longer considered marginal grafts.

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“…Rates of vascular complications in adults vary in the literature between 2% and 11.6% for hepatic artery thrombosis and 0%‐2.3% for portal vein thrombosis . Doyle et al.…”

Section: Discussionmentioning

confidence: 99%

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Moussaoui

Toso

Nowacka

et al. 2017

Pediatric Transplantation

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“…(8, 14) Other studies have suggested that the diagnosis of hepatocellular carcinoma (HCC) may be also associated with poorer outcomes when accepting living-donor partial grafts,(15–17) an association that has never been investigated in DD split grafts. Although more recent studies have shown improved outcomes in split liver transplantation, (8, 10, 13, 14, 18, 19) there has been no significant increase in its use over the past decade (1, 20)…”

Section: Introductionmentioning

confidence: 99%

Deceased-Donor Split-Liver Transplantation in Adult Recipients: Is the Learning Curve Over?

Cauley

Vakili

Fullington

et al. 2013

Journal of the American College of Surgeons

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Background Infants have the highest waitlist mortality of all liver transplant candidates. Deceased-donor split liver transplantation, a technique that provides both an adult and pediatric graft, may be the best way to decrease this disproportionate mortality. Yet concern for an increased risk to adult split recipients has discouraged its widespread adoption. We aimed to determine the current risk of graft failure in adult recipients following split liver transplantation. Study Design United Network for Organ Sharing (UNOS) data from 62,190 first-time adult recipients of deceased-donor liver transplants (1995–2010) were analyzed (889 split grafts). Bivariate risk factors (p<0.2) were included in cox proportional hazards models of the effect of transplant type on graft failure. Results Split liver recipients had an over-all hazard-ratio (HR) of graft failure of 1.26 (p<.001) compared to whole liver recipients. The split liver HR was 1.45 (p<.001) in the pre-MELD era (1995–2002), and 1.10 (p=.28) in the MELD era (2002–2010). Interaction analyses suggested an increased risk of split graft failure in Status 1 recipients and those given an exception for hepatocellular carcinoma (HCC). Excluding higher-risk recipients, split and whole grafts had similar outcomes (HR .94, p=.59). Conclusions The risk of graft failure is now similar between split and whole liver recipients in the vast majority of cases – demonstrating that the expansion of split liver allocation may be possible without increasing the overall risk of long-term graft failure in adult recipients. Further prospective analysis should examine if selection bias may account for the possible increase in risk for recipients with HCC or designated Status 1.

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“…In recent publications, results for SLT and whole liver transplantation have not differed in terms of initial graft function or long‐term outcomes. These data support SLT as a consistent tool for expanding the donor organ pool and reducing mortality on the waiting list 26‐29. However, some specific complications related to this technique may still be open to investigation.…”

Section: Discussionmentioning

confidence: 61%

Spontaneous hepatitis B surface antigen seroclearance confers appreciably high rates except in patients with relapse of hepatitis

Xin

Xuan

2008

Hepatology

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We fully agree with Dr. Yu and co-workers that maintaining the initial doses of ribavirin during the treatment play a decisive role in attaining sustained virological response (SVR). According to Davis et al., 2 the impact of dose reduction on SVR rates appeared to be greatest in patients who had to reduce the assigned ribavirin dose within the initial 12 weeks of treatment. For this reason, we tried to maintain the starting ribavirin doses in almost all our patients during the first 4 weeks of treatment and allowed them to use epoetin rather than reducing ribavirin dosage. As a consequence, our study is not completely comparable to those quoted by Dr. Yu.Only 22 (4.5%) of our patients experienced ribavirin dose reduction during the first 12 weeks overall. In four cases, this dose reduction was required during the first 4 weeks. Therefore, of 185 patients with RVR, four (2.1%) have had dose reduction of ribavirin. By contrast, of 310 patients without RVR, very few patients (19 [6.0%]) have had ribavirin dose reduction. In our experience, the ribavirin exposure appears to be one of several factors influencing the likelihood of achieving RVR, at least in patients infected with HCV genotype 1. It has been recently reported that neither early virologic response nor SVR are adversely affected by ribavirin dose reduction unless it is greater than 60% of the cumulative dose. 3,4 Similar findings are reported in patients infected with genotype 2 and 3. 5 On the basis of these data, we suppose that a starting weight-based dose of ribavirin rather than a reduction of ribavirin dosage during treatment might have a major impact as a modifiable favorable predictor of SVR in patients with chronic HCV genotype 1 infection.

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Donor and recipient selection leads to good patient and graft outcomes for right lobe split transplantation versus whole graft liver transplantation in adult recipients

Cited by 24 publications

References 20 publications

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Deceased-Donor Split-Liver Transplantation in Adult Recipients: Is the Learning Curve Over?

Spontaneous hepatitis B surface antigen seroclearance confers appreciably high rates except in patients with relapse of hepatitis

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