Split and whole liver transplantation outcomes: a comparative cohort study

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Donation

Background:

• The North Italian Transplant program (NITp) initiated a dedicated split liver transplantation (SLT) program in November 1997.
• Over five years, 1,449 liver transplants were performed across seven centers using 1,304 cadaveric donors.
• This included 1,126 whole liver transplantations (WLT) and 323 SLTs.

Purpose of the Study:

• To evaluate the outcomes of SLT compared to WLT.
• To identify factors influencing patient and graft survival in liver transplantation.
• To assess the impact of SLT on organ donor utilization and waiting list mortality.

Main Methods:

• Analysis of 1,449 liver transplants performed between November 1997 and November 2002.
• Categorization of SLTs into left lateral segment (LLS), right trisegment liver (RTL), and modified split liver (MSL) grafts.
• Multivariate analysis to identify independent predictors of graft failure and patient survival.

Main Results:

• SLTs demonstrated 3-year patient and graft survival rates (79.4% and 72.2%) not significantly different from WLT (80.6% and 74.9%).
• Recipients of WLT or LLS grafts had significantly better outcomes than those receiving RTL or MSL grafts (P < 0.03-0.04).
• Independent risk factors for graft failure included donor age >60, RTL grafts, low transplant center volume (<50/year), urgent status, prolonged ischemia time (>7 hours), and retransplantation.

Conclusions:

• SLT achieves comparable survival to WLT and significantly reduces pediatric in-list mortality (to 3%) and adult patient dropout rates (from 27.2% to 16.2%).
• RTL and MSL grafts showed outcomes similar to marginal whole liver grafts.
• The study supports wider adoption of SLT protocols, deeming organizational challenges surmountable.