Optimizing the use of donated cadaver livers: Analysis and policy development to increase the application of split-liver transplantation

Emond, Jean C.; Freeman, Richard B.; Renz, John F.; Yersiz, Hasan; Rogiers, Xavier; Busuttil, Ronald W.

doi:10.1053/jlts.2002.34639

Cited by 65 publications

(52 citation statements)

References 37 publications

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“…This flexibility may require that centers collaborate to benefit the overall donor pool and compromise on individual access for global benefit. In Europe, where cadaver organs are allocated to centers, rather than specific patients, increased flexibility is available for recipient selection and coordination (71). The result has been standing agreements between centers for sharing of partial grafts that have been quite successful (31,72).…”

Section: Obstacles Impeding Further Utilization Of Sltmentioning

confidence: 99%

“…Traditionally, patients have not been involved in the selection of cadaver donors; but the extended use of 'marginal' donors has brought the issue of consent to the forefront. The parameters governing these issues have not been defined and the boundary between a marginal or 'expanded' donor, and a standard donor, remains the purview of individual programs (71). The question of the boundary between technical innovation/improvement and clinical research involving investigational review committees and separate informed consent is particularly relevant to SLT.…”

Section: Obstacles Impeding Further Utilization Of Sltmentioning

confidence: 99%

See 1 more Smart Citation

Split-Liver Transplantation: A Review

Renz

Yersiz

Reichert

et al. 2003

American Journal of Transplantation

Self Cite

104

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Split-liver transplantation (SLT), a procedure where one cadaver liver is divided to provide for two recipients, offers immediate expansion of the existing cadaver donor pool. To date, the principal beneficiaries of SLT have been adult/pediatric recipient pairs with excellent outcomes reported; however, the current scarcity of cadaver organs has renewed interest in expanding these techniques to include two adult recipients from one adult cadaver donor. Significant obstacles to the widespread application of SLT exist and must be resolved by the transplant community before greater utilization can be realized. This manuscript reviews the historic background, surgical techniques, current results, and obstacles impeding further application of SLT.

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Section: Obstacles Impeding Further Utilization Of Sltmentioning

confidence: 99%

Section: Obstacles Impeding Further Utilization Of Sltmentioning

confidence: 99%

Split-Liver Transplantation: A Review

Renz

Yersiz

Reichert

et al. 2003

American Journal of Transplantation

Self Cite

104

View full text Add to dashboard Cite

show abstract

“…Intraoperatively an eligible liver should have a soft consistence (fat < 20%), a sharp edge and no evidence of hepatic hypoperfusion [46][47][48].…”

Section: Selection Of Donorsmentioning

confidence: 99%

Partial liver transplantation-living donor liver transplantation and split liver transplantation

Müller

Mehrabi

Schmied

et al. 2007

Nephrology Dialysis Transplantation

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In the last two decades, liver transplantation (LTx) has become the treatment of choice for several liver diseases including hepatocellular carcinoma in selected cases. Improvements in surgical and anesthesiological procedures have increased patient survival after LTx, resulting in excellent 1-year survival rates. The ratelimiting factor to further increase the number of LTx is the extreme shortage of suitable organs with the consequence that pediatric and adult patients are dying on the waiting list. At present, mortality reported for pediatric and adult patients on the waiting list is 10 to 20%. Living-donor liver transplantation and split liver transplantation are measurements to reduce the severe lack of cadaveric grafts by expanding the donor pool. Major centers around the world now routinely perform partial LTx in infants and adults with survival success equivalent to that after full-size liver transplantation.

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“…Most investigators found that a preoperative dialysis requirement resulted in decreased posttransplant survival compared with patients with normal renal function (2)(3)(4)(5)(6)(7)(8)(9)(10). In this setting, and because of changes in organ allocation and broadening criteria for acceptable donor organs (11,12), the role of combined liver/kidney transplantation is becoming important. Efforts have been made to define the patients who benefit most from this procedure (13,14), and there may be an increase in the number of combined transplants being performed (15).…”

Section: Introductionmentioning

confidence: 99%

Impact of Dialysis and Older Age on Survival after Liver Transplantation

Dellon

Galanko

Medapalli

et al. 2006

American Journal of Transplantation

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Because creatinine is heavily weighed in the MELD (model for end-stage liver disease) score, we sought to determine the impact of MELD-based organ allocation on outcomes after transplantation in the preand post-MELD eras, focusing on recipients over age 65 on dialysis prior to transplant. A total of 20 196 patients from the UNOS database were analyzed. Comparing the pre-MELD to MELD era, there was a 41% increase in patients on dialysis (p < 0.0001), and a 117% increase in combined liver/kidney transplants (p < 0.0001). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who received liver transplant alone was 56.8% and 76.4%, respectively (p = 0.13). In the MELD era these rates were 50.7% and 77.8% (p = 0.04). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who underwent combined liver/kidney transplantation was 25.0% and 83.2%, respectively (p = 0.0002). In the MELD era, these rates were 67.0% and 82.5% (p = 0.18). In conclusion, a greater proportion of patients in the MELD era are on dialysis prior to transplant, and more receive combined liver/kidney transplants compared with the pre-MELD era. Candidates over age 65 who are on dialysis at the time of transplant have decreased survival after isolated liver transplantation.

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Optimizing the use of donated cadaver livers: Analysis and policy development to increase the application of split-liver transplantation

Cited by 65 publications

References 37 publications

Split-Liver Transplantation: A Review

Split-Liver Transplantation: A Review

Partial liver transplantation-living donor liver transplantation and split liver transplantation

Impact of Dialysis and Older Age on Survival after Liver Transplantation

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