Full‐left‐full‐right split liver transplantation for adult recipients: a systematic review and meta‐analysis

Abstract

Summary Full‐left‐full‐right split liver transplantation (FSLT) for adult recipients, may increase the availability of liver grafts, reduce waitlist time, and benefit recipients with below‐average body weight. However, FSLT may lead to impaired graft and patient survival. This study aims to assess outcomes after FSLT. Five databases were searched to identify studies concerning FSLT. Incidences of complications, graft‐ and patient survival were assessed. Discrete data were pooled with random‐effect models. Graft and patient survival after FSLT were compared with whole liver transplantation (WLT) according to the inverse variance method. Vascular complications were reported in 25/273 patients after FSLT (Pooled proportion: 6.9%, 95%CI: 3.1–10.7%, I2: 36%). Biliary complications were reported in 84/308 patients after FSLT (Pooled proportion: 25.6%, 95%CI: 19–32%, I2: 44%). Pooled proportions of graft and patient survival after 3 years follow‐up were 72.8% (95%CI: 67.2–78.5, n = 231) and 77.3% (95%CI: 66.7–85.8, n = 331), respectively. Compared with WLT, FSLT was associated with increased graft loss (pooled HR: 2.12, 95%CI: 1.24–3.61, P = 0.006, n = 189) and patient mortality (pooled HR: 1.81, 95%CI: 1.17–2.81, P = 0.008, n = 289). FSLT was associated with high incidences of vascular and biliary complications. Nevertheless, long‐term patient and graft survival appear acceptable and justify transplant benefit in selected patients.

Split liver transplantation with extended right grafts on adult recipients: A propensity score matching analysis

“… 8 . 14–17 In the present study, all evaluated outcomes were similar between groups. In a similar matched‐pair recipient study by Moussaoui et al., postoperative complications and 1‐year patient and graft survival were similar between split and whole graft adult and pediatric recipients 18 .…”

“…15 However, 3-year graft and patient survival were 78.8% and 72.8%, respectively, which the authors state still supports a benefit for most patients on the waiting list. 15 A matched-pair study of SLT to WLT recipients at a single institution in China revealed similar 5-year survival rates (80.8% vs. 81.6%; P = .465). 19 However, the SLT group had more Clavien-Dindo grade III-IV complications, longer hospital stays, and higher 45-day mortality.…”

“…A meta‐analysis by Sneiders et al. showed increased incidence of both vascular and biliary complications and impaired 90‐day and 1 year survival in full‐left‐full‐right SLT in adult recipients 15 . However, 3‐year graft and patient survival were 78.8% and 72.8%, respectively, which the authors state still supports a benefit for most patients on the waiting list 15 .…”

“…showed increased incidence of both vascular and biliary complications and impaired 90‐day and 1 year survival in full‐left‐full‐right SLT in adult recipients 15 . However, 3‐year graft and patient survival were 78.8% and 72.8%, respectively, which the authors state still supports a benefit for most patients on the waiting list 15 . A matched‐pair study of SLT to WLT recipients at a single institution in China revealed similar 5‐year survival rates (80.8% vs. 81.6%; P = .465) 19 .…”

Split liver transplantation for two adult recipients: A collective review of Korean experience

“…Since one liver graft can be shared between two adult recipients, SLT2A increases the number of available grafts and reduces the waitlist time and mortality [3][4][5]. This technique might especially favor smaller adolescents and adult patients who are disadvantaged on the waiting list to receive a timely size-matched graft [6][7][8]. The world-first case of SLT2A was reported in 1989 [1].…”