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Higher retransplantation rate following extended right split‐liver transplantation: An analysis from the eurotransplant liver follow‐up registry
Author(s) -
Andrassy Joachim,
Wolf Sebastian,
Lauseker Michael,
Angele Martin,
van Rosmalen Marieke D.,
Samuel Undine,
Rogiers Xavier,
Werner Jens,
Guba Markus
Publication year - 2018
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.24980
Subject(s) - medicine , liver transplantation , univariate analysis , liver disease , model for end stage liver disease , transplantation , surgery , hazard ratio , multivariate analysis , confidence interval
Split‐liver transplantation has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant Liver Allocation System (ELAS) envisages that the extended right lobes (ERLs) after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of extended right lobe transplantation (ERLT) in comparison to whole liver transplantation (WLT) recipients remains unclear. Data on all liver transplantations performed between 2007 and 2013 were retrieved from the Eurotransplant Liver Follow‐up Registry (n = 5351). Of these, 5013 (269 ERL, 4744 whole liver) could be included. The impact of the transplant type on patient and graft survival was evaluated using univariate and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times were significantly prolonged for ERLTs ( P < 0.001). Patient survival was not different between ERLT and WLT. In the univariate analysis, ERLT had a significantly higher risk for retransplantation ( P = 0.02). For WLT, the risk for death gradually and significantly increased with laboratory Model for End‐Stage Liver Disease (MELD) scores of >20. For ERLT, this effect was seen already with laboratory MELD scores of >14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs. Liver Transplantation 24 26–34 2018 AASLD.