OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers. Copyright © 2013 by Lippincott Williams & Wilkins.

A prospective policy development to increase split-liver transplantation for 2 adult recipients: Results of a 12-year multicenter collaborative study / P. Aseni, T.M. De Feo, L. De Carlis, U. Valente, M. Colledan, U. Cillo, G. Rossi, V. Mazzaferro, M. Donataccio, N. De Fazio, E. Andorno, P. Burra, A. Giacomoni, A.O. Slim, C. Sposito, A. De Gasperi, B. Antonelli, G. Zanus, D. Pinelli, M. Zambelli, N. Morelli, R. Valente, G. Grosso, M. Mantovani, G. Piccolo. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - 259:1(2014), pp. 157-165. [10.1097/SLA.0b013e31827da6c9]

A prospective policy development to increase split-liver transplantation for 2 adult recipients: Results of a 12-year multicenter collaborative study

T.M. De Feo
Secondo
;
G. Rossi;V. Mazzaferro;C. Sposito;B. Antonelli;M. Zambelli;M. Mantovani
Penultimo
;
2014

Abstract

OBJECTIVE: To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. BACKGROUND: Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. METHODS: We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. RESULTS: Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) CONCLUSIONS: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers. Copyright © 2013 by Lippincott Williams & Wilkins.
Liver transplantation; Segmental liver transplantation; Split-liver transplantation; Surgical complications; Surgical technique; Adolescent; Adult; Algorithms; Female; Graft Survival; Humans; Liver Transplantation; Male; Middle Aged; Policy Making; Postoperative Complications; Prospective Studies; Retrospective Studies; Transplants; Young Adult; Surgery
Settore MED/18 - Chirurgia Generale
2014
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/335133
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