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Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results under the Korean MELD Score-based Allocation Policy.

Authors
  • Park, Gil Chun1
  • Hwang, Shin2
  • Song, Gi Won1
  • Jung, Dong Hwan1
  • Ha, Tae Yong1
  • Ahn, Chul Soo1
  • Moon, Deok Bog1
  • Kim, Ki Hun1
  • Yoon, Young In1
  • Kang, Woo Hyoung1
  • Cho, Hwui Dong1
  • Choi, Jin Uk1
  • Kim, Minjae1
  • Na, Byeong Gon1
  • Kim, Sang Hoon1
  • Lee, Sung Gyu1
  • 1 Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. , (North Korea)
  • 2 Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. [email protected] , (North Korea)
Type
Published Article
Journal
Journal of Korean medical science
Publication Date
Sep 21, 2020
Volume
35
Issue
37
Identifiers
DOI: 10.3346/jkms.2020.35.e304
PMID: 32959541
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Split liver transplantation (SLT) has been occasionally performed in Korea. This study compared the incidence and prognosis of SLT with whole liver transplantation (WLT) in adult patients. Between June 2016 and November 2019, 242 adult patients underwent a total of 256 deceased donor liver transplantation operations. SLT was performed in 7 patients (2.9%). The mean age of SLT donors was 29.7 ± 7.4 years, and the mean age of recipients was 55.7 ± 10.6 years, with the latter having a mean model for end-stage liver disease score of 34.6 ± 3.1. Mean split right liver graft weight was 1,228.6 ± 149.7 g and mean graft-recipient weight ratio was 1.97 ± 0.39. Of the seven SLT recipients, Korean Network for Organ Sharing (KONOS) status was one in status 1, one in status 2 and five in status 3. The graft (P = 0.72) and patient (P = 0.84) survival rates were comparable in the SLT and WLT groups. Following propensity score matching, graft (P = 0.61) and patient (P = 0.91) survival rates remained comparable in the two groups. Univariate analysis showed that pretransplant ventilator support and renal replacement therapy were significantly associated with patient survival, whereas KONOS status category and primary liver diseases were not. Multivariate analysis showed that pretransplant ventilator support was an independent risk factor for patient survival. Survival outcomes were similar in adult SLT and WLT recipients, probably due to selection of high-quality grafts and low-risk recipients. Prudent selection of donors and adult recipients for SLT may expand the liver graft pool for pediatric patients without affecting outcomes in adults undergoing SLT. © 2020 The Korean Academy of Medical Sciences.

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