Adult-to-Child Split-Liver Transplantation Is a Safe and Effective Way to Meet Demand for Grafts

Bryan DeBusk, PhD

July 14, 2008

July 14, 2008 (Paris, France) — The review of split-liver transplants conducted at a large center over a 10-year period has shown that the procedure can be used to provide grafts for a larger number of patients without sacrificing the function or survival of the graft or patient.

Vittorio Corno, MD, a surgeon at the Ospedali Riuniti Largo Barozzi Liver and Lung Transplantation Center, in Bergamo, Italy, presented the results of the study here at the 2008 Joint International Congress of ILTS, ELITA & LICAGE.

"We started a pediatric liver transplant program back in October 1997, [which was] followed soon (in 1999) by an adult transplant program," Dr. Corno told Medscape Transplantation. "From the beginning we adopted a liberal policy of splitting [livers for transplant], and we tried to split every splittable liver, in particular using the standard adult-to-child split procedure. After 10 years and almost 300 split-liver transplantations performed, we reviewed the results."

Of 676 liver transplants performed at the center between October 1997 and October 2007, 247 children and 34 adults received an adult/child split liver consisting of an extended right graft (12 children, 26 adults) or left lateral segment (230 children) of the liver, or received an adult/adult split liver (8 adults) consisting of the full right or full left (5 children) portion of the liver. Dr. Corno and his colleagues compared the outcomes of these transplants with the outcomes of whole-liver grafts received by 249 adults and 63 children during the same time period.

Although biliary complications were observed in 295 of the adult patients who received a split-liver graft, compared with 15% of the adult patients who received a whole-liver graft (= .0506), graft survival among adult recipients of split-liver transplants was higher than graft survival among recipients of whole grafts at 1 year (88% vs 84%) and at 5 years (85% vs 78%). Patient survival was also higher among split-liver recipients at 1 year (91% vs 85%) and at 5 years (88% vs 80%).

The incidence of biliary complications was higher among children who received split-liver transplants (42% vs 5%; < .0001), but the complications did not appear to affect graft or patient survival. Graft survival was higher among children who received split-liver transplants at 1 year (84% vs 78%) and at 5 years (80% vs 74%), and patient survival was higher among this group at both time points (1 year, 91% vs. 84%; 5 years, 87% vs 83%).

Dr. Corno acknowledged potential concerns about the common complications of split-liver transplants in both adults and children, noting that "biliary complications are significantly higher with partial grafts, both from split liver and from living donors," but added that "their incidence does not seem to have a negative impact on the patient [or on] graft survival."

Michael Ramsay, MD, secretary and treasurer of the International Liver Transplantation Society (ILTS), president of the Baylor Research Institute, and chief of service for the department of anesthesiology and pain management at Baylor University Medical Center, in Dallas, Texas, told Medscape Transplantation that the experience at Ospedali Riuniti was successful in meeting the demand for livers. "The use of split-liver grafts to successfully increase the number of grafts available, especially for the pediatric waiting list, is very positive, especially if the survival rates are maintained for both graft and recipient," Dr. Ramsay said. "This center demonstrated excellent results and very successfully expanded the donor pool."

Dr. Corno suggested that the procedure could be more widely used to meet the unmet need for organs at major transplant centers. "[The] adult-to-child split-liver procedure is effective in expanding the organ-donor pool," Dr. Corno concluded. "The results are even better than those [obtained] using a whole size graft, in particular when the procedure is performed by a team from a high-volume center [that [performs] split-liver transplantation."

The study did not receive commercial support. Neither Dr. Corno nor Dr. Ramsay have disclosed any relevant financial relationships.

2008 Joint International Congress of ILTS, ELITA & LICAGE: Abstract 543. Presented July 11, 2008.


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