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Right lobe split liver transplantation versus whole liver transplantation in adult recipients: A systematic review and meta‐analysis
Author(s) -
Wan Ping,
Li Qigen,
Zhang Jianjun,
Xia Qiang
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24135
Subject(s) - medicine , liver transplantation , odds ratio , meta analysis , transplantation , cochrane library , gastroenterology , confidence interval , surgery , subgroup analysis
Split liver transplantation (SLT) has proven to be an effective technique to reduce the mortality of children on the waiting list, but whether creating 2 split grafts from 1 standard‐criteria whole liver would compromise outcomes of adult recipients remains uncertain. We conducted this meta‐analysis to compare outcomes of right lobe SLT and whole liver transplantation (WLT) in adult patients. PubMed, Embase, and the Cochrane Library were searched for relevant articles published before December 2014. Outcomes assessed were patient survival (PS), graft survival (GS), and major surgical complications after transplantation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to synthesize the results. Seventeen studies with a total of 48,457 patients met the full inclusion criteria. PS and GS rates were all found to be equivalent between SLT and WLT recipients. However, SLT was associated with higher rates of overall biliary complications (OR = 1.66; 95% CI = 1.29‐2.15; P < 0.001), bile leaks (OR = 4.30; 95% CI = 2.97‐6.23; P < 0.001), overall vascular complications (OR = 1.81; 95% CI = 1.29‐2.53; P < 0.001), hepatic artery thromboses (OR = 1.71; 95% CI = 1.17‐2.50; P = 0.005), and outflow tract obstructions (OR = 4.17; 95% CI = 1.75‐9.94; P = 0.001). No significant difference was observed in incidences of biliary stricture, portal vein complications, postoperative bleeding requiring surgical treatments, primary nonfunction, and retransplantations. In subgroup analyses, biliary and vascular complications only increased after ex vivo SLT rather than in situ SLT, and SLT recipients had more retransplantations if they matched with WLT recipients in terms of urgent status. In conclusion, adult right lobe SLT was associated with increased biliary and vascular complications compared with WLT, but it did not show significant inferiority in PSs and GSs. Liver Transpl 21:928‐943, 2015 . © 2015 AASLD.