Are split liver grafts a suitable option in high-risk liver transplant recipients?

Abstract

Purpose of review To assess the outcomes of split liver transplantation (SLT) in adults and children and evaluate its role in high-risk recipients with a high model for end-stage liver disease (MELD) score, an urgent indication or requiring retransplantation. Recent findings Split liver grafts in general have equivalent long-term survival outcomes to whole grafts despite an increase in biliary complications. Recent success and technical advances have encouraged use of these grafts in high-risk recipients. Split liver grafts can be used successfully in recipients with a high MELD score if there is adequate weight-matching. There are mixed results in urgent indication recipients and for retransplantation such that use in this group of patients remains controversial. Summary SLT addresses donor shortages by facilitating the transplant of two recipients from the same donor liver. By using careful donor and recipient selection criteria, SLT can achieve equivalent long-term outcomes to whole grafts. These grafts have been used successfully in recipients with a high MELD score, but should be used selectively in urgent indication recipients and for retransplantation.

Current Understanding of Marginal Grafts in Liver Transplantation

“…Elevated susceptibility to biliary complications stands as a significant risk factor in SLT [112,113,120]. The use of microvascular arterial reconstruction should be considered as one might in the case of pediatric living donor liver transplantation.…”

“…Currently, most SLT outcomes remain uncertain, leading many transplant centers to adopt stringent donor selection criteria, typically favoring young, non-obese and hemodynamically stable donors. Similarly, recipient selection criteria, especially those necessitating urgent or re-transplantation, are rarely extended [120]. Research findings demonstrate that the 5-year survival rate of adult LT recipients (63% -69%) tends to be lower than that of whole LT [134][135][136][137].…”

“…The success of SLT in adult recipients has fueled an interest in broadening recipient selection criteria [120]. Chul et al conducted a single-center study in Korea, comparing 86 adult patients who received ERGs with 303 adult patients who received WLGs.…”

Split liver transplantation: Current status and future trend

“…55,56 The post-operative graft and patient long-term survival rates for both LLL in paediatric recipients and eRL in adult recipients are generally comparable to the best results achievable with other techniques. 42,49,[57][58][59][60][61][62] However, there is a slightly higher rate of early post-operative complications and early mortality compared with WLT, although without statistical significance. 19,63,64 In current research, the majority of LLL splitting utilizes the in situ approach.…”

“…14 A longer CIT has also been reported as an independent factor affecting graft and patient survival rates. 20,30,49,60,79,96 A CIT of 10 h may be a critical number, and some studies have reported significant differences in outcomes when CIT is over 10 h compared with less than 10 h. 97 Besides, an appropriate GRWR is crucial to ensuring the safety and effectiveness of the transplant and has become a common criterion for evaluating whether certain liver grafts are suitable for transplantation. In LDLT, the recommended minimum GRWR is 0.6%, but in most cases, GRWR should be greater than 0.8%.…”