The shortage of suitable donor organs, forced the transplantation community to develop alternative transplantation techniques to increase the donor pool. Especially for the pediatric population, split liver transplantation (SLT) has gained ethically acceptance as a procedure reducing pediatric waiting list mortality. Apart from the benefit in childhood transplantation SLT is still not fully accepted which may cause of the potential elevated risk of complications of the adult recipient receiving the right extended graft (Segment: I+V to VIII). Although there are many data of favourable short-term results from transplantation of the right extended split-grafts until now there exist no data concerning the long-term outcome of this procedure. Performing one of the largest split liver programs we therefore chose to compare the above mentioned procedure with whole organ liver transplantation procedure using matched pairs. Since January 1993 to December 2004 one-hundred-twenty-four primary transplantations of extended right split liver grafts (SLTs) to adult recipients were performed. These recipients were matched to recipients of whole liver transplantations (WLTs, n=373). Matching was performed blinded to the patients outcome and according to the following criteria: 1) indication for transplantation, 2) United Network for Organ Sharing (UNOS-) status I-IV, 3) recipient age (<55, >55 years), 4) donor age (<55, >55 years), 5) cold ischemic time (< 15 hours) 6) year of transplantation (1. period 1993-95; 2. period 1996-2000; 3.period: 2001-2004). Using these criteria a total of 70 matched pairs of SLT-WLT recipients were identified. The outcome of these recipients was retrospectively analyzed. The mean follow up time of these recipients was 26.5 month. The median age of the recipients was 48 (16-69) years, in both groups. Sixteen percent of the recipients in our study were highly urgent cases (UNOS status I), seventeen percent of them were urgent cases (UNOS status II), 67% of the recipients were transplanted electively (UNOS status III/ IV). The 2- and 5-year cumulative patient survival rates after SLT were 86.3% and 82.6%, after WLT it was 78.4% and 75.6%, respectively (log rank p= 0.2127). With regard to the 2- and 5-year cumulative graft survival rates we also did not observe significant differences between the groups (SLT: 77.3% both time points vs.71.9% and 65.8%; log rank p= 0.3822). The rates of primary non-function, poor function as well as the early and late biliary and vascular complications and the number of rejections was comparable for SLT and WLT. Conclusion: In this analysis the 2- and 5-year patient and graft survival rate after SLT were comparable with those after WLT. There were no major differences in the total number of biliary, vascular complications, especially with regard to the late complications. In conclusion, SLT of the extended right lobe, performed in an experienced transplant centre, does not put the adult recipient to an increased risk. Further SLT technique reduces death in the pediatric population awaiting liver transplantation. Therefore SLT is a safety and sufficient procedure to hamper persistent lack of suitable deceased donor organs.
Volume : 6
Issue : 4
Pages : 14
Department of General und Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.