Outcomes with split liver transplantation are equivalent to those with whole organ transplantation

M. B Majella Doyle, Erin Maynard, Yiing Lin, Neeta Vachharajani, Surendra Shenoy, Christopher Anderson, Mark Earl, Jeffrey A. Lowell, William C. Chapman

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Abstract

Background: Split liver transplantation is an excellent option for expansion of the donor organ pool. However, reports of increased morbidity in split liver recipients may limit use of this technique. Study Design: This was a single center retrospective analysis investigating split liver transplantation. Between August 1, 1995 and March 30, 2012, 53 of 1,261 (4.2%) recipients received split liver grafts. Results: The 1-, 5-, and 10-year patient and graft survivals in adult recipients of split grafts were 95.5%, 89.5%, and 89.5%, respectively. Survival was similar to that of whole organ recipients (p = 0.15). Twenty-three adults received split grafts: 18 (78%) were right trisegment grafts, 4 (17.4%) were right lobes, and 1 (4.3%) was a left lobe. The mean cold ischemic time was 5.7 hours (±2.4 hours [SD]) and warm ischemic time was 36 minutes (±5.5 minutes). Four (17%) recipients required hepatic artery reconstruction; 5 (21.7%) required a caval-venous patch, and 5 (21.7%) had Roux-en-Y reconstruction of the bile duct. No venous conduits were required. Thirty children received split grafts (median age 1.2 years, range 0.1 to 16.4 years) and had a median weight of 8.6 kg (range 3.6 to 45 kg). Pediatric split 1-, 5-, and 10-year overall and graft survival rates were 96.7%, 80.0%, 80.0%, and 93.3%, 76.8, and 76.8%, respectively. Complications included retransplantation in 3 (10.0%), bile leak in 5 (16.7%), hepatic arterial thrombosis in 2 (6.7%), bowel perforation in 2 (6.7%), and bleeding in 2 (6.7%). The mean donor age was 22.4 months (±8.9) months and body mass index was 22.8 kg/m2 (±3.3 kg/m2). Conclusions: We demonstrated excellent outcomes in adult and pediatric recipients using carefully selected donors for liver splitting. We recommend escalation of the use of split liver transplants to expand the donor pool for cadaveric liver transplantation.

Original languageEnglish (US)
Pages (from-to)102-112
Number of pages11
JournalJournal of the American College of Surgeons
Volume217
Issue number1
DOIs
StatePublished - Jul 2013
Externally publishedYes

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Organ Transplantation
Liver Transplantation
Transplants
Tissue Donors
Liver
Graft Survival
Pediatrics
Cold Ischemia
Warm Ischemia
Venae Cavae
Hepatic Artery
Bile Ducts
Bile
Body Mass Index
Thrombosis
Survival Rate
Hemorrhage
Morbidity
Weights and Measures
Survival

ASJC Scopus subject areas

  • Surgery

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Outcomes with split liver transplantation are equivalent to those with whole organ transplantation. / Doyle, M. B Majella; Maynard, Erin; Lin, Yiing; Vachharajani, Neeta; Shenoy, Surendra; Anderson, Christopher; Earl, Mark; Lowell, Jeffrey A.; Chapman, William C.

In: Journal of the American College of Surgeons, Vol. 217, No. 1, 07.2013, p. 102-112.

Research output: Contribution to journalArticle

Doyle, MBM, Maynard, E, Lin, Y, Vachharajani, N, Shenoy, S, Anderson, C, Earl, M, Lowell, JA & Chapman, WC 2013, 'Outcomes with split liver transplantation are equivalent to those with whole organ transplantation', Journal of the American College of Surgeons, vol. 217, no. 1, pp. 102-112. https://doi.org/10.1016/j.jamcollsurg.2013.03.003
Doyle, M. B Majella ; Maynard, Erin ; Lin, Yiing ; Vachharajani, Neeta ; Shenoy, Surendra ; Anderson, Christopher ; Earl, Mark ; Lowell, Jeffrey A. ; Chapman, William C. / Outcomes with split liver transplantation are equivalent to those with whole organ transplantation. In: Journal of the American College of Surgeons. 2013 ; Vol. 217, No. 1. pp. 102-112.
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title = "Outcomes with split liver transplantation are equivalent to those with whole organ transplantation",
abstract = "Background: Split liver transplantation is an excellent option for expansion of the donor organ pool. However, reports of increased morbidity in split liver recipients may limit use of this technique. Study Design: This was a single center retrospective analysis investigating split liver transplantation. Between August 1, 1995 and March 30, 2012, 53 of 1,261 (4.2{\%}) recipients received split liver grafts. Results: The 1-, 5-, and 10-year patient and graft survivals in adult recipients of split grafts were 95.5{\%}, 89.5{\%}, and 89.5{\%}, respectively. Survival was similar to that of whole organ recipients (p = 0.15). Twenty-three adults received split grafts: 18 (78{\%}) were right trisegment grafts, 4 (17.4{\%}) were right lobes, and 1 (4.3{\%}) was a left lobe. The mean cold ischemic time was 5.7 hours (±2.4 hours [SD]) and warm ischemic time was 36 minutes (±5.5 minutes). Four (17{\%}) recipients required hepatic artery reconstruction; 5 (21.7{\%}) required a caval-venous patch, and 5 (21.7{\%}) had Roux-en-Y reconstruction of the bile duct. No venous conduits were required. Thirty children received split grafts (median age 1.2 years, range 0.1 to 16.4 years) and had a median weight of 8.6 kg (range 3.6 to 45 kg). Pediatric split 1-, 5-, and 10-year overall and graft survival rates were 96.7{\%}, 80.0{\%}, 80.0{\%}, and 93.3{\%}, 76.8, and 76.8{\%}, respectively. Complications included retransplantation in 3 (10.0{\%}), bile leak in 5 (16.7{\%}), hepatic arterial thrombosis in 2 (6.7{\%}), bowel perforation in 2 (6.7{\%}), and bleeding in 2 (6.7{\%}). The mean donor age was 22.4 months (±8.9) months and body mass index was 22.8 kg/m2 (±3.3 kg/m2). Conclusions: We demonstrated excellent outcomes in adult and pediatric recipients using carefully selected donors for liver splitting. We recommend escalation of the use of split liver transplants to expand the donor pool for cadaveric liver transplantation.",
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T1 - Outcomes with split liver transplantation are equivalent to those with whole organ transplantation

AU - Doyle, M. B Majella

AU - Maynard, Erin

AU - Lin, Yiing

AU - Vachharajani, Neeta

AU - Shenoy, Surendra

AU - Anderson, Christopher

AU - Earl, Mark

AU - Lowell, Jeffrey A.

AU - Chapman, William C.

PY - 2013/7

Y1 - 2013/7

N2 - Background: Split liver transplantation is an excellent option for expansion of the donor organ pool. However, reports of increased morbidity in split liver recipients may limit use of this technique. Study Design: This was a single center retrospective analysis investigating split liver transplantation. Between August 1, 1995 and March 30, 2012, 53 of 1,261 (4.2%) recipients received split liver grafts. Results: The 1-, 5-, and 10-year patient and graft survivals in adult recipients of split grafts were 95.5%, 89.5%, and 89.5%, respectively. Survival was similar to that of whole organ recipients (p = 0.15). Twenty-three adults received split grafts: 18 (78%) were right trisegment grafts, 4 (17.4%) were right lobes, and 1 (4.3%) was a left lobe. The mean cold ischemic time was 5.7 hours (±2.4 hours [SD]) and warm ischemic time was 36 minutes (±5.5 minutes). Four (17%) recipients required hepatic artery reconstruction; 5 (21.7%) required a caval-venous patch, and 5 (21.7%) had Roux-en-Y reconstruction of the bile duct. No venous conduits were required. Thirty children received split grafts (median age 1.2 years, range 0.1 to 16.4 years) and had a median weight of 8.6 kg (range 3.6 to 45 kg). Pediatric split 1-, 5-, and 10-year overall and graft survival rates were 96.7%, 80.0%, 80.0%, and 93.3%, 76.8, and 76.8%, respectively. Complications included retransplantation in 3 (10.0%), bile leak in 5 (16.7%), hepatic arterial thrombosis in 2 (6.7%), bowel perforation in 2 (6.7%), and bleeding in 2 (6.7%). The mean donor age was 22.4 months (±8.9) months and body mass index was 22.8 kg/m2 (±3.3 kg/m2). Conclusions: We demonstrated excellent outcomes in adult and pediatric recipients using carefully selected donors for liver splitting. We recommend escalation of the use of split liver transplants to expand the donor pool for cadaveric liver transplantation.

AB - Background: Split liver transplantation is an excellent option for expansion of the donor organ pool. However, reports of increased morbidity in split liver recipients may limit use of this technique. Study Design: This was a single center retrospective analysis investigating split liver transplantation. Between August 1, 1995 and March 30, 2012, 53 of 1,261 (4.2%) recipients received split liver grafts. Results: The 1-, 5-, and 10-year patient and graft survivals in adult recipients of split grafts were 95.5%, 89.5%, and 89.5%, respectively. Survival was similar to that of whole organ recipients (p = 0.15). Twenty-three adults received split grafts: 18 (78%) were right trisegment grafts, 4 (17.4%) were right lobes, and 1 (4.3%) was a left lobe. The mean cold ischemic time was 5.7 hours (±2.4 hours [SD]) and warm ischemic time was 36 minutes (±5.5 minutes). Four (17%) recipients required hepatic artery reconstruction; 5 (21.7%) required a caval-venous patch, and 5 (21.7%) had Roux-en-Y reconstruction of the bile duct. No venous conduits were required. Thirty children received split grafts (median age 1.2 years, range 0.1 to 16.4 years) and had a median weight of 8.6 kg (range 3.6 to 45 kg). Pediatric split 1-, 5-, and 10-year overall and graft survival rates were 96.7%, 80.0%, 80.0%, and 93.3%, 76.8, and 76.8%, respectively. Complications included retransplantation in 3 (10.0%), bile leak in 5 (16.7%), hepatic arterial thrombosis in 2 (6.7%), bowel perforation in 2 (6.7%), and bleeding in 2 (6.7%). The mean donor age was 22.4 months (±8.9) months and body mass index was 22.8 kg/m2 (±3.3 kg/m2). Conclusions: We demonstrated excellent outcomes in adult and pediatric recipients using carefully selected donors for liver splitting. We recommend escalation of the use of split liver transplants to expand the donor pool for cadaveric liver transplantation.

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