Long-term results after adult ex situ split liver transplantation since its introduction in 1987
| Autor: | Frank Lehner, Jürgen Klempnauer, Tim O. Lankisch, Alexander Kaltenborn, Moritz Kleine, Harald Schrem, Lampros Kousoulas, Lea Zachau |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Time Factors Cholangitis Sclerosing Anastomotic Leak Article Primary sclerosing cholangitis Plasma Hepatic Artery medicine Humans Survival rate Aged Retrospective Studies Intraoperative Care Proportional hazards model business.industry Portal Vein Biliary Leakage Mortality rate Biliary Complication Graft Survival Retrospective cohort study Thrombosis Length of Stay Liver Failure Acute Middle Aged medicine.disease Cardiac surgery Surgery Liver Transplantation Survival Rate Cardiothoracic surgery Female Middle Hepatic Vein business Erythrocyte Transfusion Learning Curve Abdominal surgery |
| Zdroj: | World Journal of Surgery |
| ISSN: | 1432-2323 |
| Popis: | Background Split liver transplantation is still discussed controversially. Utilization of split liver grafts has been declining since a change of allocation rules for the second graft abolished incentives for German centres to perform ex situ splits. We therefore analysed our long-term experiences with the first ex situ split liver transplant series worldwide. Methods A total of 131 consecutive adult ex situ split liver transplants (01.12.1987–31.12.2010) were analysed retrospectively. Results Thirty-day mortality rates and 1- and 3-year patient survival rates were 13, 76.3, and 66.4 %, respectively. One- and three-year graft survival rates were 63.4 and 54.2 %, respectively. The observed 10-year survival rate was 40.6 %. Continuous improvement of survival from era 1 to 3 was observed (each era: 8 years), indicating a learning curve over 24 years of experience. Patient and graft survival were not influenced by different combinations of transplanted segments or types of biliary reconstruction (p > 0.05; Cox regression). Patients transplanted for primary sclerosing cholangitis had better survival (p = 0.021; log-rank), whereas all other indications including acute liver failure (13.6 %), acute and chronic graft failure (9.1 %) had no significant influence on survival (p > 0.05; log-rank). Biliary complications (27.4 %) had no significant influence on patient or graft survival (p > 0.05; log-rank). Hepatic artery thrombosis (13.2 %) had a significant influence on graft survival but not on patient survival (p = 0.002, >0.05, respectively; log-rank). Conclusions Split liver transplantation can be used safely and appears to be an underutilized resource that may benefit from liberal allocation of the second graft. |
| Databáze: | OpenAIRE |
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