Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement

Perito, Emily R.; Roll, Garrett R.; Dodge, Jennifer L.; Rhee, Sue; Roberts, John P.

doi:10.1097/tp.0000000000002249

Cited by 80 publications

(99 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the risks associated with SLT did decrease significantly with improved techniques and experience, the authors found that the number of SLT patients remained at ~60 per year. This is consistent with the finding by Perito et al of SLT being underused with only 3.8% of potentially splittable livers used for SLT . In addition, Sasaki et al caution against the conclusions made by other authors that SLT can achieve comparable graft/patient outcomes compared with WLT, noting that SLT is still more hazardous in the early period after transplantation.…”

supporting

confidence: 82%

See 1 more Smart Citation

Split‐Liver Allocation: An Underused Opportunity to Expand Access to Liver Transplantation

Lai

2019

Liver Transpl

View full text Add to dashboard Cite

supporting

confidence: 82%

“…Despite being introduced decades ago and frequently used in the pediatric population, SLT remains underused in adult candidates with stagnant case volumes . From 2004 to 2014, utilization of split livers in adults varied merely by 0.2% (between 1.0% and 1.2%) .…”

mentioning

confidence: 99%

Split‐Liver Allocation: An Underused Opportunity to Expand Access to Liver Transplantation

Lai

2019

Liver Transpl

View full text Add to dashboard Cite

“…These findings should be considered in the context of work by Hsu et al that showed nearly half of the children who died on the waiting list never received a single offer of a liver . Furthermore, recent research by Perito et al showed that approximately half of the most splitable livers, by strict criteria, were not used for SLT …”

Section: Discussionmentioning

confidence: 91%

Expansion of the Liver Donor Supply Through Greater Use of Split‐Liver Transplantation: Identifying Optimal Recipients

et al. 2019

View full text Add to dashboard Cite

The increased use of split liver transplantation (SLT) represents one strategy to increase the supply of organs. Although outcomes after SLT and whole liver transplantation (WLT) are similar on average among pediatric recipients, we hypothesized that the relationship between graft type and outcomes may vary depending on patient, donor, and surgical characteristics. We evaluated graft survival among pediatric (<18 years), deceased-donor, liver-only transplant recipients from March, 2002, until December, 2015, using data from the the Scientific Registry of Transplant Recipients. Graft survival was assessed in a Cox proportional hazards model, with and without effect modification between graft type and donor, recipient, and surgical characteristics, to identify conditions where the risk of graft loss for SLT and WLT were similar. In a traditional multivariable model, characteristics associated with graft loss included donor age >50 years, recipient weight <10 kg, acute hepatic necrosis, autoimmune diseases, tumor, public insurance, and cold ischemia time (CIT) >8 hours. In an analysis that explored whether these characteristics modified the relationship between graft type and graft loss, many characteristics associated with loss actually had similar outcomes irrespective of graft type including weight <10 kg, acute hepatic necrosis, autoimmune diseases, and tumor. In contrast, several subgroups had worse outcomes when SLT was used, including recipient weight 10-35 kg, non-BA cholestasis, and metabolic disease. Allocation score, share type, or CIT did not modify risk of graft type and graft failure. Although one might anticipate that individuals with higher rates of graft loss would be worse candidates for SLT, data suggest that these patients actually have similar rates of graft loss. These findings can guide surgical decision-making and may support policy changes that promote the increased use of SLT for specific pediatric recipients. This article is protected by copyright. All rights reserved.

show abstract

“…[1][2][3] However, access to timely LT is challenging for children due to the scarcity of size-matched pediatric deceased donors. [5][6][7][8][9] Despite these approaches, obtaining size-matched partial liver grafts that are small enough for many pediatric recipients remains a problem. [5][6][7][8][9] Despite these approaches, obtaining size-matched partial liver grafts that are small enough for many pediatric recipients remains a problem.…”

Section: Liver Transplantation (Lt) Is An Established Life-saving Trementioning

confidence: 99%

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

Goldaracena

Echeverri

Kehar

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

Usage of “large‐for‐size” left lateral segment (LLS) liver grafts in children with high graft to recipient weight ratio (GRWR) is controversial due to concerns about increased recipient complications. During the study period, 77 pediatric living donor liver transplantations (LDLTs) with LLS grafts were performed. We compared recipients with GRWR ≥2.5% (GR‐High = 50) vs GRWR <2.5% (GR‐Low = 27). Median age was higher in the GR‐Low group (40 vs 8 months, P> .0001). Graft (GR‐High: 98%, 98%, 98% vs GR‐Low: 96%, 93%, 93%) and patient (GR‐High: 98%, 98%, 98% vs GR‐Low: 100%, 96%, 96%) survival at 1, 3, and 5 years was similar between groups (P = NS). Overall complications were also similar (34% vs 30%; P = .8). Hepatic artery and portal vein thrombosis following transplantation was not different (P = NS). Delayed abdominal fascia closure was more common in GR‐High patients (17 vs 1; P = .002). Subgroup analysis comparing recipients with GRWR ≥4% (GR‐XL = 20) to GRWR <2.5% (GRWR‐Low = 27) revealed that delayed abdominal fascia closure was more common in the GR‐XL group, but postoperative complications and graft and patient survival were similar. We conclude that pediatric LDLT with large‐for‐size LLS grafts is associated with excellent clinical outcomes. There is an increased need for delayed abdominal closure with no compromise of long‐term outcomes. The use of high GRWR expands the donor pool and improves timely access to the benefits of transplantation without extra risks.

show abstract

Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement

Cited by 80 publications

References 16 publications

Split‐Liver Allocation: An Underused Opportunity to Expand Access to Liver Transplantation

Split‐Liver Allocation: An Underused Opportunity to Expand Access to Liver Transplantation

Expansion of the Liver Donor Supply Through Greater Use of Split‐Liver Transplantation: Identifying Optimal Recipients

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

Contact Info

Product

Resources

About