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Survival Outcomes in Split Compared With Whole Liver Transplantation
Author(s) -
Chul Yoon Kyung,
Song Sanghee,
Jwa EunKyoung,
Lee Sanghoon,
Man Kim Jong,
Kim Okkyoung,
Kyun Hong Suk,
Yi NamJoon,
Lee KwangWoong,
Soo Kim Myoung,
Hwang Shin,
Suh KyungSuk,
Lee SukKoo
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.25196
Subject(s) - medicine , liver transplantation , malignancy , gastroenterology , surgery , transplantation , liver disease , survival rate
Split‐liver transplantation (SLT) should be cautiously considered because the right trisection (RTS) graft can be a marginal graft in adult recipients. Herein, we analyzed the outcomes of RTS‐SLT in Korea, where >75% of adult liver transplantations are performed with living donor liver transplantation. Among 2462 patients who underwent deceased donor liver transplantations (DDLTs) from 2005 to 2014, we retrospectively reviewed 86 (3.5%) adult patients who received a RTS graft (RTS‐SLT group). The outcomes of the RTS‐SLT group were compared with those of 303 recipients of whole liver (WL; WL‐DDLT group). Recipient age, laboratory Model for End‐Stage‐Liver Disease (L‐MELD) score, ischemia time, and donor‐to‐recipient weight ratio (DRWR) were not different between the 2 groups ( P > 0.05). However, malignancy was uncommon (4.7% versus 36.3%), and the donor was younger (25.2 versus 42.7 years) in the RST‐SLT group than in the WL‐DDLT group ( P < 0.05). The technical complication rates and the 5‐year graft survival rates (89.0% versus 92.8%) were not different between the 2 groups ( P > 0.05). The 5‐year overall survival (OS) rate (63.1%) and graft‐failure‐free survival rate (63.1%) of the RTS‐SLT group were worse than that of the WL‐DDLT group (79.3% and 79.3%; P < 0.05). The factors affecting graft survival rates were not definite. However, the factors affecting OS in the RTS‐SLT group were L‐MELD score >30 and DRWR ≤1.0. In the subgroup analysis, OS was not different between the 2 groups if the DRWR was >1.0, regardless of the L‐MELD score ( P > 0.05). In conclusion, a sufficient volume of the graft estimated from DRWR‐matching could lead to better outcomes of adult SLTs with a RTS graft, even in patients with high L‐MELD scores.