ScholarWorks@중앙대학교

초록

Objectives: To compare ex-situ deceased split liver transplants to the gold standard splits from living donors in adult recipients Summary of Background Data: Split liver transplant for adult recipients represents an important modality to bridge the deficit between organ availability and need. However, historical outcomes have suggested an increase in vascular and biliary complications with questionable survival compared to whole grafts. While in-situ splitting is theoretically a good idea, logistic concerns hamper its ability to be easily reproduced. Our group has extensive experience with LDLTs and represents a technically mature program that has adapted these lessons to adult ex-situ split liver transplants. Methods: We present a large single center cohort of ex-situ splits and compare them to the gold standard of splits – represented by LDLTs. We identified 65 adult split liver transplants and compared them to 91 ideal gold standard LDLTs without SFSS. Results: Our data show a very low incidence of vascular complications in the entire experience and bile leak rates for split livers equivalent to LDLTs. While one year patient survival showed a trend towards lower survival for all splits vs. LDLTs without SFSS (93.8% vs. 98.9%; P=0.076) this trend fell away after the first year at the 3 and 5-year time points. Risk factors for 1-year and overall survival on univariate or multivariate analysis included CIT≥6hours, MELD≥25, recipient BMI<20, increasing warm ischemia time, portal vein thrombosis and donor factors including BMI≥30 and diabetes. Conclusion: In conclusion, we find that adult ex-situ split liver transplants are able to achieve over 90% one-year graft and patient survival and long-term survival that is equivalent to LDLTs.

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