Split versus living-related adult liver transplantation: a systematic review and meta-analysis

The outcomes of split liver transplantation between recipients of deceased donor split liver transplant (SLT) or live donor liver transplants (LDLT) have never been compared in meta-analysis. It is important to understand graft and recipient survival between recipients of these grafts.

Databases were searched for relevant articles over the previous 20 years (MEDLINE, Embase, Cochrane Library and Google Scholar). Meta-analyses were performed using both fixed- and random-effects models. Patient survival and graft survival were obtained using the inverse variance hazard ratio method.

There were differences in the characteristics of the donors and recipients. Donors of the SLT were younger compared to LDLT cohort [mean difference (MD) = - 11.12 years (- 15.41 to - 6.84), p < 0.001] whilst recipients of LDLT were younger [MD = - 2.06 years (- 1.12 to - 3.01), p < 0.001]. Significantly fewer men received grafts after SLT, 45%, compared to those receiving LDLT, 55%, [OR = 0.66 (0.55 to 0.80), p < 0.001]. There were no significant differences detected in postoperative complications, graft and patient 1-, 3- and 5-year survival between the SLT and LDLT cohorts.

There is no apparent difference in overall survival, graft survival or complications between recipients of SLT or LDLT. However, characteristics of the donor and recipients differed suggesting the need for adequate risk-adjusted assessment of outcomes.