Split and whole liver transplantation outcomes: A comparative cohort study
A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed...
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| Veröffentlicht in: | Liver transplantation 2006-03, Vol.12 (3), p.402-410 |
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| creator | Cardillo, Massimo De Fazio, Nicola Pedotti, Paola De Feo, Tullia Fassati, Luigi Rainero Mazzaferro, Vincenzo Colledan, Michele Gridelli, Bruno Caccamo, Lucio DeCarlis, Luciano Valente, Umberto Andorno, Enzo Cossolini, Mariangelo Martini, Cristiano Antonucci, Adelmo Cillo, Umberto Zanus, Giacomo Baccarani, Umberto Scalamogna, Mario NITp Liver Transplantation Working Group |
| description | A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1,126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow‐up of 22 months, SLTs achieved a 3‐yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, 7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in‐list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique. Liver Transpl 12:402–410, 2006. © 2006 AASLD. |
| doi_str_mv | 10.1002/lt.20720 |
| format | Article |
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After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1,126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow‐up of 22 months, SLTs achieved a 3‐yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, <50 annual transplants volume, urgent transplantation (United Network for Organ Sharing (UNOS) status I and IIA), ischemia time of >7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in‐list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique. Liver Transpl 12:402–410, 2006. © 2006 AASLD.</description><identifier>ISSN: 1527-6465</identifier><identifier>EISSN: 1527-6473</identifier><identifier>DOI: 10.1002/lt.20720</identifier><identifier>PMID: 16598843</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Analysis of Variance ; Cohort Studies ; Female ; Graft Rejection ; Graft Survival ; Humans ; Italy ; Liver Failure - diagnosis ; Liver Failure - mortality ; Liver Failure - surgery ; Liver Transplantation - adverse effects ; Liver Transplantation - methods ; Male ; Middle Aged ; Postoperative Complications - mortality ; Probability ; Prognosis ; Proportional Hazards Models ; Risk Assessment ; Survival Analysis ; Tissue and Organ Procurement ; Tissue Donors ; Treatment Outcome</subject><ispartof>Liver transplantation, 2006-03, Vol.12 (3), p.402-410</ispartof><rights>Copyright © 2006 American Association for the Study of Liver Diseases</rights><rights>Copyright 2006 AASLD</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4190-bbb721b0b9cf65f4dd6bdf46ca568cff391e5fd237366be7c6d82a4139c885f43</citedby><cites>FETCH-LOGICAL-c4190-bbb721b0b9cf65f4dd6bdf46ca568cff391e5fd237366be7c6d82a4139c885f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flt.20720$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flt.20720$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16598843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cardillo, Massimo</creatorcontrib><creatorcontrib>De Fazio, Nicola</creatorcontrib><creatorcontrib>Pedotti, Paola</creatorcontrib><creatorcontrib>De Feo, Tullia</creatorcontrib><creatorcontrib>Fassati, Luigi Rainero</creatorcontrib><creatorcontrib>Mazzaferro, Vincenzo</creatorcontrib><creatorcontrib>Colledan, Michele</creatorcontrib><creatorcontrib>Gridelli, Bruno</creatorcontrib><creatorcontrib>Caccamo, Lucio</creatorcontrib><creatorcontrib>DeCarlis, Luciano</creatorcontrib><creatorcontrib>Valente, Umberto</creatorcontrib><creatorcontrib>Andorno, Enzo</creatorcontrib><creatorcontrib>Cossolini, Mariangelo</creatorcontrib><creatorcontrib>Martini, Cristiano</creatorcontrib><creatorcontrib>Antonucci, Adelmo</creatorcontrib><creatorcontrib>Cillo, Umberto</creatorcontrib><creatorcontrib>Zanus, Giacomo</creatorcontrib><creatorcontrib>Baccarani, Umberto</creatorcontrib><creatorcontrib>Scalamogna, Mario</creatorcontrib><creatorcontrib>NITp Liver Transplantation Working Group</creatorcontrib><creatorcontrib>NITp Liver Transplantation Working Group</creatorcontrib><title>Split and whole liver transplantation outcomes: A comparative cohort study</title><title>Liver transplantation</title><addtitle>Liver Transpl</addtitle><description>A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1,126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow‐up of 22 months, SLTs achieved a 3‐yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, <50 annual transplants volume, urgent transplantation (United Network for Organ Sharing (UNOS) status I and IIA), ischemia time of >7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in‐list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique. Liver Transpl 12:402–410, 2006. © 2006 AASLD.</description><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Italy</subject><subject>Liver Failure - diagnosis</subject><subject>Liver Failure - mortality</subject><subject>Liver Failure - surgery</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver Transplantation - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications - mortality</subject><subject>Probability</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Survival Analysis</subject><subject>Tissue and Organ Procurement</subject><subject>Tissue Donors</subject><subject>Treatment Outcome</subject><issn>1527-6465</issn><issn>1527-6473</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM9LwzAYhoMobk7Bv0ByEi-dSdqkrbcx_MnAg_NckjRhlbSpSbqx_95oh548fS8fDw8vLwCXGM0xQuTWhDlBOUFHYIopyROW5enxb2Z0As68_0AIY1qiUzDBjJZFkaVT8PLWmyZA3tVwt7FGQdNslYPB8c73hneBh8Z20A5B2lb5O7iAMfTcxf9WxbyxLkAfhnp_Dk40N15dHO4MvD_cr5dPyer18Xm5WCUywyVKhBA5wQKJUmpGdVbXTNQ6Y5JTVkit0xIrqmuS5iljQuWS1QXhGU5LWRSRT2fgevT2zn4OyoeqbbxUJrZVdvAVywtSUppH8GYEpbPeO6Wr3jUtd_sKo-p7t8qE6me3iF4dnINoVf0HHoaKQDICu8ao_b-iarUehV-E8nc7</recordid><startdate>200603</startdate><enddate>200603</enddate><creator>Cardillo, Massimo</creator><creator>De Fazio, Nicola</creator><creator>Pedotti, Paola</creator><creator>De Feo, Tullia</creator><creator>Fassati, Luigi Rainero</creator><creator>Mazzaferro, Vincenzo</creator><creator>Colledan, Michele</creator><creator>Gridelli, Bruno</creator><creator>Caccamo, Lucio</creator><creator>DeCarlis, Luciano</creator><creator>Valente, Umberto</creator><creator>Andorno, Enzo</creator><creator>Cossolini, Mariangelo</creator><creator>Martini, Cristiano</creator><creator>Antonucci, Adelmo</creator><creator>Cillo, Umberto</creator><creator>Zanus, Giacomo</creator><creator>Baccarani, Umberto</creator><creator>Scalamogna, Mario</creator><creator>NITp Liver Transplantation Working Group</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200603</creationdate><title>Split and whole liver transplantation outcomes: A comparative cohort study</title><author>Cardillo, Massimo ; 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After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1,126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow‐up of 22 months, SLTs achieved a 3‐yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of >60 yr, RTL transplant, <50 annual transplants volume, urgent transplantation (United Network for Organ Sharing (UNOS) status I and IIA), ischemia time of >7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in‐list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique. Liver Transpl 12:402–410, 2006. © 2006 AASLD.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>16598843</pmid><doi>10.1002/lt.20720</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Analysis of Variance Cohort Studies Female Graft Rejection Graft Survival Humans Italy Liver Failure - diagnosis Liver Failure - mortality Liver Failure - surgery Liver Transplantation - adverse effects Liver Transplantation - methods Male Middle Aged Postoperative Complications - mortality Probability Prognosis Proportional Hazards Models Risk Assessment Survival Analysis Tissue and Organ Procurement Tissue Donors Treatment Outcome |
| title | Split and whole liver transplantation outcomes: A comparative cohort study |
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