The imbalance between the organ supply and the number of potential transplant recipients led to consideration of expanded-criteria liver donors.
Objective—
To compare right-lobe split-liver transplants (RL-SLTs) with orthotopic liver transplants (OLTs) from donors more than 70 years old (OLT-O) and OLTs from donors less than 55 years old (OLT-Y).
Methods—
Seventy-one patients who received an RL-SLT were matched for age, sex, and Model for End-stage Liver Disease score with 71 patients who underwent OLT-O and 142 patients who underwent OLT-Y. Clinical outcomes were compared between groups.
Results—
Longer operation time was associated with RL-SLT (P < .001) as well as more blood loss (P = .03) and transfusions (P = .05). Postoperative morbidity was less in the OLT-Y group, with a lower rate of grades III to IV Clavien-Dindo complication (30%), compared with values in OLT-O (52%) and RL-SLT (38%). Kaplan-Meier analysis demonstrated better 1-year and 3-year survival rates in the OLT-Y group (97% and 92%, respectively), compared with 92% and 86.3%, respectively, in the RL-SLT group; and 84.5% and 73%, respectively, in the OLT-O group (P = .03). Kaplan-Meier analysis also demonstrated differences between the groups in terms of 1-year and 3-year graft survival rates, which were 92% and 86%, respectively, in OLT-Y; 77% and 66%, respectively, in the OLT-O, and 84.2% and 76.6%, respectively, in the RL-SLT group (P = .01).
Conclusion—
Even if OLT-Y guarantees better patient and graft survival, both RL-SLT and OLT-O can be used safely to expand the pool of liver donors, showing acceptable clinical results and complications rates.
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References
1.
MazzaferroVRegaliaEDociR. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–699.
2.
BurrATShahSA. Disparities in organ allocation and access to liver transplantation in the USA. Expert Rev Gastroenterol Hepatol. 2010;4(2):133–140.
3.
AzoulayDAstarciogluIBismuthH. Split-liver transplantation. The Paul Brousse policy. Ann Surg. 1996;224(6):737–746.
4.
GrandeLRullARimolaA. Outcome of patients undergoing orthotopic liver transplantation with elderly donors (over 60 years). Transplant Proc. 1997;29(8):3289–3290.
5.
EmreSSchwartzMEAltacaG. Safe use of hepatic allografts from donors older than 70 years. Transplantation. 1996;62(1):62–65.
6.
BismuthHMorinoMCastaingD. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg. 1989;76(7):722–724.
7.
PichlmayrRRingeBGubernatisGHaussJBunzendahlH. [Transplantation of a donor liver to 2 recipients (splitting transplantation)—a new method in the further development of segmental liver transplantation]. Langenbecks Arch Chir. 1988;373(2):127–130.
8.
BurdelskiMMRogiersX. What lessons have we learned in pediatric liver transplantation?J Hepatol. 2005;42(1):28–33.
9.
EmondJCWhitingtonPFThistlethwaiteJR. Transplantation of two patients with one liver. Analysis of a preliminary experience with ‘split-liver’ grafting. Ann Surg. 1990;212(1):14–22.
10.
AseniPDe FeoTMDe CarlisL. A prospective policy development to increase split-liver transplantation for 2 adult recipients: results of a 12-year multicenter collaborative study. Ann Surg. 2014;259(1):157–165.
11.
DurandFRenzJFAlkoferB. Report of the Paris consensus meeting on expanded criteria donors in liver transplantation. Liver Transpl. 2008;14(12):1694–1707. doi:10.1002/lt.21668.
12.
FengSGoodrichNPBragg-GreshamJL. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783–790.
13.
GhobrialRMYersizHFarmerDG. Predictors of survival after In vivo split liver transplantation: analysis of 110 consecutive patients. Ann Surg. 2000;232(3):312–323.
14.
WilmsCWalterJKapteinM. Long-term outcome of split liver transplantation using right extended grafts in adulthood: a matched pair analysis. Ann Surg. 2006;244(6):865–872; discussion 872–863.
15.
AdamRMcMasterPO'GradyJG. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl. 2003;9(12):1231–1243.
16.
GraziGLCesconMRavaioliM. A revised consideration on the use of very aged donors for liver transplantation. Am J Transplant. 2001;1(1):61–68.
17.
CameronAMGhobrialRMYersizH. Optimal utilization of donor grafts with extended criteria: a single-center experience in over 1000 liver transplants. Ann Surg. 2006;243(6):748–753; discussion 753–745.
18.
BacchellaTGalvaoFHJesus de AlmeidaJLFigueiraERde MoraesACesar MachadoMC. Marginal grafts increase early mortality in liver transplantation. Sao Paulo Med J. 2008;126(3):161–165.
19.
KaratzasTOlsonLCiancioG. Expanded liver donor age over 60 years for hepatic transplantation. Transplant Proc. 1997;29(7):2830–2831.
20.
SerranoMTGarcia-GilAArenasJ. Outcome of liver transplantation using donors older than 60 years of age. Clin Transplant. 2010;24(4):543–549.
MerionRMRushSHDykstraDMGoodrichNFreemanRBJrWolfeRA. Predicted lifetimes for adult and pediatric split liver versus adult whole liver transplant recipients. Am J Transplant. 2004;4(11):1792–1797.
26.
AzoulayDCastaingDAdamR. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. 2001;233(4):565–574.
27.
GoldaracenaNQuinonezEMendezP. Extremely marginal liver grafts from deceased donors have outcome similar to ideal grafts. Transplant Proc. 2012;44(7):2219–2222.
28.
AlamoJMBarreraLMarinLM. Results of liver transplantation with donors older than 70 years: a case-control study. Transplant Proc. 2011;43(6):2227–2229.
29.
EmreSUmmanV. Split liver transplantation: an overview. Transplant Proc. 2011;43(3):884–887.
30.
BismuthH. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6(1):3–9.
31.
AzoulayDMarin-HargreavesGCastaingDBismuthH. Ex situ splitting of the liver: the versatile Paul Brousse technique. Arch Surg. 2001;136(8):956–961.
32.
MemeoRSubarDde'AngelisNSalloumCAzoulayD. A simple technique for procuring liver allografts while protecting arterial vessels. Prog Transplant. 2014;24(3):271–272. doi:10.7182/pit2014419.
33.
StarzlTEIwatsukiSEsquivelCO. Refinements in the surgical technique of liver transplantation. Semin Liver Dis. 1985;5(4):349–356.
34.
OlthoffKMKulikLSamsteinB. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943–949. doi:10.1002/lt.22091.
35.
StrasbergSMHowardTKMolmentiEPHertlM. Selecting the donor liver: risk factors for poor function after orthotopic liver transplantation. Hepatology. 1994;20(4 pt 1):829–838.
36.
HabibSBerkBChangCC. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12(3):440–447.
37.
MerionRMGoodrichNPFengS. How can we define expanded criteria for liver donors?J Hepatol. 2006;45(4):484–488.
38.
LuceyMR. How will patients be selected for transplantation in the future?Liver Transpl. 2004;10(10suppl 2):S90–S92.
39.
NardoBMasettiMUrbaniL. Liver transplantation from donors aged 80 years and over: pushing the limit. Am J Transplant. 2004;4(7):1139–1147.
40.
LeeWCChanKMChouHS. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg. 2013;258(2):306–311. doi:10.1097/SLA.0b013e3182754b8e.
41.
MallikMCallaghanCJHopeM. Comparison of liver transplantation outcomes from adult split liver and circulatory death donors. Br J Surg. 2012;99(6):839–847.
42.
DecosterELTroisiRSainz-BarrigaM. Improved results for adult split liver transplantation with extended right lobe grafts: could we enhance its application?Transplant Proc. 2009;41(8):3485–3488.
43.
BroeringDCToppSSchaeferU. Split liver transplantation and risk to the adult recipient: analysis using matched pairs. J Am Coll Surg. 2002;195(5):648–657.
