Outcome following right-extended split liver transplantation in the recent transplant era: Single-center analysis of a German transplant center

Clinical Transplantation
Uta HerdenBjörn Nashan

Abstract

When a sufficiently high-quality liver is available, classic liver graft splitting is performed. In such cases, a small child receives the left-lateral split graft, with subsequent transplantation of the right-extended graft in an adult. We analyzed 64 patients who received right-extended liver grafts from 2007 to 2015, and compared outcomes between cases of external vs in-house graft splitting. We found excellent donor data and comparable recipient characteristics. Cold ischemic time was significantly longer for external (14 ± 2 hours; n = 38) vs internal (12 ± 2 hours; n = 26) liver graft splitting. Compared to the internal splitting group, the external liver graft splitting group showed significantly reduced 1- and 5-year patient survival (100% vs 84%; P = .035) and higher rates of biliary (24% vs 12%) and vascular (8% vs 0%) complications. The outcomes following right-extended split LTX are disappointing given the excellent organ quality. External liver graft splitting was associated with worse outcome and surgical complication rates. This may be related to the prolonged cold ischemic time due to twofold transportation, as well as the ignorance of the splitting procedure details and related pitfalls.

References

Sep 1, 1968·Annals of Surgery·T E StarzlK A Porter
Mar 17, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·S FengR M Merion
Apr 7, 2006·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Massimo CardilloUNKNOWN NITp Liver Transplantation Working Group
Mar 12, 2008·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·D C BroeringX Rogiers
Jun 5, 2008·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·K W LeeR A Montgomery
Aug 13, 2011·Current Opinion in Organ Transplantation·Solomon M AzouzAnnie Fecteau
Dec 1, 2013·Journal of Clinical and Experimental Hepatology·Dronacharya RouthRajesh Godara
Apr 3, 2015·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Ping WanQiang Xia
Jan 25, 2017·Transplantation·Björn NashanHans Lilie
Jun 27, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Michael W RossMarco Spada

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Citations

Jul 25, 2019·Transplantation·James D PerkinsJorge D Reyes
Jan 21, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Vladimir J LozanovskiArianeb Mehrabi
Nov 23, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Vladimir J LozanovskiArianeb Mehrabi

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