Increased use of split liver grafts in adult recipients following implementation of a pediatric liver transplant program

Abstract

Background Split liver transplantation (SLT) is a strategy to address organ shortage, but is a technically more demanding procedure than whole graft liver transplantation (LT). We aimed to determine the outcomes following SLT in adult recipients as well as to highlight the impact that having a pediatric LT program has on SLT implementation. Methods All SLTs conducted at a single‐center from 2010 to 2019 were identified. Patient data was obtained through retrospective review of the electronic medical record. Kaplan–Meier analysis assessed primary outcomes of 1‐,3‐, and 5‐year graft and patient survival. Results We identified 37 SLTs performed at our institution from 2010 to 2019. Twenty‐four donated livers resulted in 21 extended right lobes and 16 left lateral segments for adults and pediatrics recipients, respectively. Eighty‐one percent (30/37) of the SLTs were performed after introduction of the combined pediatric program in 2016. 13/24 donor livers were split with both grafts allocated and used at our institution and 92% occurred after introduction of the pediatric program. Graft survival rates at 1‐, 3‐, and 5‐years were 94% in adult recipients and 100% for all time periods in pediatric recipients. Actuarial post‐transplant patient survival was 100% at 1‐, 3‐, and 5‐years in both. Conclusions The introduction of a pediatric liver transplantation program resulted in more than a fourfold increase in the number of SLTs performed at our center. Increase in allocation and use of both grafts at our institution was also seen.

Split liver transplantation with extended right grafts on adult recipients: A propensity score matching analysis

“…11 The increase in cold ischemia time associated with additional travel and surgical complexity and especially with ex-situ splitting, may have been mitigated by the introduction of a pediatric liver transplantation program at our institution. 6 The continued implementation of the split liver variance on a national level may also decrease this risk of graft failure due associated with CIT. Analysis of preoperative liver transplant recipient characteristics in the unmatched cohort revealed a higher proportion of split liver recipients were female.…”

“…The splitting technique used has been previously described. 6 Briefly, division of the liver parenchyma was performed 1 cm to the right of the falciform ligament with either Cavitron Ultrasonic Surgical Aspirator, crush clamp technique or Harmonic device depending on center availability and surgeon preferences. Unfortunately, no data is available on how it was performed in each individual case.…”

“…Allocation of the split grafts was discussed thoroughly previously. 6 UW solution was used for graft preservation in all transplants.…”

“…Nonetheless, at our institution, we have seen an increase in the number of split liver transplants performed after the initiation of our pediatric liver transplant program. 6 Split liver transplantation is technically challenging and has been associated with higher rates of postoperative complications leading to concerns about graft and patient survival. Historically, research has found an increased incidence of biliary and vascular complications in split liver recipients.…”

“…However, the ethics around the implication of this variance and its impact on organ allocation and split utilization is still to be evaluated. Nonetheless, at our institution, we have seen an increase in the number of split liver transplants performed after the initiation of our pediatric liver transplant program 6 …”