Right Ex Situ Split Grafts for Adult Liver Transplantation: A Multicenter Benchmarking Analysis

Area of Science:

• Hepatobiliary surgery
• Transplantation medicine
• Graft utilization strategies

Background:

• Graft shortage in liver transplantation necessitates innovative solutions.
• Ex-situ split liver transplantation (SLT) offers a potential strategy to increase graft availability.
• Established benchmarks in whole liver transplantation (WLT) provide a reference for evaluating SLT outcomes.

Purpose of the Study:

• To analyze outcomes of adult right ex-situ split graft liver transplantations (RSLT).
• To compare RSLT outcomes with established benchmarks from WLT.
• To identify specific complications associated with ex-situ RSLT.

Main Methods:

• Retrospective multicenter cohort study of adult RSLT from 2014-2022.
• Evaluation of 1-year graft and recipient survival rates.
• Assessment of overall morbidity using the Comprehensive Complication Index (CCI©) and specific post-transplant complications.
• Comparison of results against published low-risk adult WLT benchmarks.

Main Results:

• 1-year recipient survival (96%) and graft survival (91.5%) were within WLT benchmarks.
• Overall morbidity (41.8 CCI points) was comparable to WLT benchmarks (<42.1).
• Cut surface bile leaks (17%) were frequent but did not impact graft survival; early hepatic artery thrombosis (HAT) (4.9%) exceeded WLT benchmarks (≤4.1%) and affected early graft survival.

Conclusions:

• Adult right ex-situ SLT demonstrates 1-year morbidity and mortality rates comparable to low-risk WLT benchmarks.
• Cut surface bile leaks and early HAT are specific complications of SLT that need acknowledgment.
• These findings support the expansion of ex-situ SLT while highlighting areas for vigilance and improvement.