Outcome of Extended Right Lobe Liver Transplantations

Abstract

Split‐liver transplantation offers a solution to the organ shortage problem. However, the outcomes of extended right lobe liver transplantation (ERLT) and whether it is a suitable alternative to full‐size liver transplantation (FSLT) remain controversial. We compared the outcomes of ERLT and FSLT in adult recipients of 43,409 first deceased donor liver transplantations using Cox regression. We also analyzed 612 ERLT and 1224 FSLT 1:2 matched cases to identify factors that affect ERLT outcome. The risk of graft loss was significantly higher following ERLT than following FSLT during the first posttransplantation year in the matched and unmatched collective (hazard ratio [HR], 1.39 and 1.27 and P = 0.01 and 0.006, respectively). Every additional hour of cold ischemia time (CIT) increased the risk of 1‐year graft loss by 10% in the ERLT group compared with only 3% in the FSLT group (P = 0.003 and <0.001, respectively). Importantly, the outcome of ERLT and FSLT did not differ significantly if the CIT was below 10 hours (HR, 0.71; P = 0.22). One‐year graft and patient survival were lower in high‐risk ERLT recipients with a Model for End‐Stage Liver Disease (MELD) score of ≥20 (HR, 1.88; P = 0.03 and HR, 2.03; P = 0.02). In the male recipient–male donor combination, ERLT recipients had a higher risk of 1‐year graft loss than FSLT recipients (HR, 2.44; P = 0.006). This was probably because of the significantly higher MELD score in ERLT recipients (P = 0.004). ERLT in adults is an adequate alternative to FSLT and offers an elegant solution to the problem of organ shortage as long as the cold storage is less than 10 hours and the recipient’s MELD score is <20.

Perioperative prothrombin complex concentrate and fibrinogen administration are associated with thrombotic complications after liver transplant

“…Thus far, several studies have examined risk factors for thrombotic events after liver transplant, in particular HAT ( 4 ). In line with our findings, split liver transplant, previous PVT, and surgery time have been described as risk factors ( 5 – 7 , 9 , 11 – 13 , 20 , 21 ). One multivariate analysis has found an association between increased blood transfusion and the occurrence of HAT ( 12 ).…”

Zinc fingers and homeoboxes 2 is required for diethylnitrosamine‐induced liver tumor formation in C57BL/6 mice

“…[ 8 ] Liver transplantation is one option, but the need far exceeds the number of donors. [ 9 ] Sorafenib and Regorafenib, the only approved drugs for HCC, have limited efficacy and extend survival by an average of fewer than 3 months, [ 10 ] and numerous other pharmaceutical compounds have failed to meet clinical end points in Phase 3 trials. [ 11 ] Thus, an improved understanding of HCC development and additional HCC biomarkers are needed to monitor and combat this increasingly prevalent cancer.…”

Impact of donor age on short-term outcomes after pediatric split liver transplantation

“…SLT significantly alleviates the problem of organ shortage ( 6 ). The influence of donor age on the recipient outcomes is unclear, and there are no clear guidelines regarding donor age ( 19 ).…”

“…In particular, SLT allows a greater number of recipients to benefit from a limited number of donors. Under appropriate conditions, a single liver graft can be shared by two recipients ( 6 , 7 ), which significantly increases the availability of donors and provides more possibilities for patients on the waiting list.…”