Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

Bowring, Mary G.; Massie, Allan B.; Schwarz, Kathleen B.; Cameron, Andrew M.; King, Elizabeth A.; Segev, Dorry L.; Mogul, Douglas

doi:10.1002/lt.26393

Cited by 20 publications

(30 citation statements)

References 21 publications

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“…21 However, the number of centers that offer living donation in the US has encouragingly increased in the last 5 years. Another option to consider is the use of split livers when living donation is not feasible, which has been associated with reduced mortality in a 2020 study, 26 but this is limited by the availability of suitable donor organs to split.…”

Section: Discussionmentioning

confidence: 99%

Sex Disparity in Liver Transplant and Access to Living Donation

Karnam

Chen

et al. 2021

JAMA Surg

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IMPORTANCEThe Model for End-stage Liver Disease (MELD)-based organ allocation system has significantly decreased mortality on the transplant waiting list for patients with end-stage liver disease. However, women have remained at a disadvantage with respect to access to deceased donor liver transplant (DDLT) even after introduction of the MELD score for organ allocation.OBJECTIVE To determine whether availability of living donation in a transplant program can offset inequity in liver transplant (LT) allocation for women. DESIGN, SETTING, AND PARTICIPANTSThis cohort study retrospectively analyzed adult patients listed for LT at the University Health Network in Toronto, Ontario, Canada. Patients included had a potential living donor (pLD) at the moment of listing. This study was performed from November 13, 2012, to May 31, 2019. A total of 1289 listed patients (830 men; 459 women) were analyzed during the study period. MAIN OUTCOMES AND MEASURESThis study performed survival analysis and competing-risk analysis to delineate how access to livers from living donors was associated with events in women vs men on the transplant waiting list (LT, death, or dropout). RESULTSOf 1289 included patients, 459 (35.6%) were women, and the mean (SD) age was 56.1 (10.0) years at assessment and listing. A total of 783 of 1289 listed patients underwent LT. Among those with no pLD at assessment, there was a higher median (range) Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) score at listing (22 [6-50] vs 19 ; P< .001) and at vs 20 [6-52]; P < .001) in women receiving DDLT. Women were at a significant disadvantage without a pLD (hazard ratio [HR], 1.29; 95% CI, 1.04-1.60; P = .01); there was no difference in access to LT with availability of a pLD (HR, 0.93; 95% CI, 0.76,-1.14; P = .44). The instantaneous rate of receiving a transplant in men with a pLD was 1.39 times higher than men who did not have a pLD (HR, 1.39; 95% CI; P < .001) and the instantaneous rate of receiving a transplant in women with a pLD was 1.92 times higher than in women who did not (HR, 1.92; 95% CI, 1.51-2.44; P < .001). The HR was 1.38 times higher in women compared with men across the MELD-Na score strata (HR, 1.38; 95% CI, 1.03-1.84; P = .03) and 2.04 times higher when the MELD-Na score was less than 20 (HR, 2.04; 95% CI, 1.31-3.14; P = .001).CONCLUSIONS AND RELEVANCE These study findings suggest that women can overcome the complex problem of allocation inequity with access to livers from living donors. Women with access only to DDLT were much more unwell than men independent of liver disease at the time of listing, dropout, or LT. Therefore, the wider availability of living donation liver transplant would be helpful in addressing the sex disparity in access to LT in the current MELD-Na era.

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Section: Discussionmentioning

confidence: 99%

Sex Disparity in Liver Transplant and Access to Living Donation

Karnam

Chen

et al. 2021

JAMA Surg

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“…The initial aim of SLT is to save two lives with a single liver. However, inappropriate preoperative evaluation of the liver donor or splitting method may bring a well-functional liver into 2 marginal donors, which may delay the recovery of graft function and even lead to graft failure or recipient death[ 22 , 23 ]. Therefore, compared with other hepatobiliary surgeries, adequate preoperative evaluation of SLT is monumental.…”

Section: Discussionmentioning

confidence: 99%

Topological approach of liver segmentation based on 3D visualization technology in surgical planning for split liver transplantation

Zhao¹,

Zhang²,

Fang³

et al. 2022

World J Gastrointest Surg

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BACKGROUND Split liver transplantation (SLT) is a complex procedure. The left-lateral and right tri-segment splits are the most common surgical approaches and are based on the Couinaud liver segmentation theory. Notably, the liver surface following right tri-segment splits may exhibit different degrees of ischemic changes related to the destruction of the local portal vein blood flow topology. There is currently no consensus on preoperative evaluation and predictive strategy for hepatic segmental necrosis after SLT. AIM To investigate the application of the topological approach in liver segmentation based on 3D visualization technology in the surgical planning of SLT. METHODS Clinical data of 10 recipients and 5 donors who underwent SLT at Shenzhen Third People’s Hospital from January 2020 to January 2021 were retrospectively analyzed. Before surgery, all the donors were subjected to 3D modeling and evaluation. Based on the 3D-reconstructed models, the liver splitting procedure was simulated using the liver segmentation system described by Couinaud and a blood flow topology liver segmentation (BFTLS) method. In addition, the volume of the liver was also quantified. Statistical indexes mainly included the hepatic vasculature and expected volume of split grafts evaluated by 3D models, the actual liver volume, and the ischemia state of the hepatic segments during the actual surgery. RESULTS Among the 5 cases of split liver surgery, the liver was split into a left-lateral segment and right tri-segment in 4 cases, while 1 case was split using the left and right half liver splitting. All operations were successfully implemented according to the preoperative plan. According to Couinaud liver segmentation system and BFTLS methods, the volume of the left lateral segment was 359.00 ± 101.57 mL and 367.75 ± 99.73 mL, respectively, while that measured during the actual surgery was 397.50 ± 37.97 mL. The volume of segment IV (the portion of ischemic liver lobes) allocated to the right tri-segment was 136.31 ± 86.10 mL, as determined using the topological approach to liver segmentation. However, during the actual surgical intervention, ischemia of the right tri-segment section was observed in 4 cases, including 1 case of necrosis and bile leakage, with an ischemic liver volume of 238.7 mL. CONCLUSION 3D visualization technology can guide the preoperative planning of SLT and improve accuracy during the intervention. The simulated operation based on 3D visualization of blood flow topology may be useful to predict the degree of ischemia in the liver segment and provide a reference for determining whether the ischemic liver tissue should be removed during the surgery.

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“…Split liver transplantation is a well documented way to increase availability of liver grafts. About 10-15% of liver grafts may be suitable for splitting, and reported series indicate that this is an option that can provide good outcomes despite somewhat increased rate of biliary and vascular complications [37][38][39]. Another, still novel way to expand the donor pool is the RAPID procedure (Resection And Partial liver auxiliary transplantation with Delayed completion hepatectomy) where small for size liver grafts (usually segment 2 þ 3) are transplanted in an auxiliary fashion with redirection of portal flow under pressure guidance to the graft to induce fast liver regeneration.…”

Section: Future Developmentmentioning

confidence: 99%

Liver transplantation for colorectal secondaries: on the way to validation

Line

2022

Current Opinion in Organ Transplantation

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Purpose of reviewLiver transplantation for nonresectable colorectal liver metastases (CRLMs) is an emerging field within transplant oncology. This review summarizes recent developments within this field. Recent findingsMore stringent selection criteria can yield 5-year survival rates that are similar to conventional indications for liver transplantation. Response to chemotherapy, low carcinoembryonic antigen levels, limited tumor volume and stable disease with observation time exceeding 12 months are fundamental requirements in this context. Radiomic analysis of pre transplant PET/computed tomography scans to determine metabolic tumor volume (MTV) in the liver seems particularly promising with regards to prediction of a favorable tumor biology. MTV values below 70 cm 3 are associated with excellent long-term survival after transplantation, whereas the MTV threshold for liver resection seem far smaller. Recent studies put into question whether technical nonresectability per se is a valid inclusion criterion for liver transplantation. In patients with high hepatic tumor burden, but otherwise favorable prognostic features as assessed by the Oslo score, liver transplantation could possibly give a clinically relevant survival benefit compared with liver resection.

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Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates

Cited by 20 publications

References 21 publications

Sex Disparity in Liver Transplant and Access to Living Donation

Sex Disparity in Liver Transplant and Access to Living Donation

Topological approach of liver segmentation based on 3D visualization technology in surgical planning for split liver transplantation

Liver transplantation for colorectal secondaries: on the way to validation

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