Split and whole liver transplantation outcomes: A comparative cohort study

Autor: Massimo Cardillo, Nicola De Fazio, Paola Pedotti, Tullia De Feo, Luigi Rainero Fassati, Vincenzo Mazzaferro, Michele Colledan, Bruno Gridelli, Lucio Caccamo, Luciano DeCarlis, Umberto Valente, Enzo Andorno, Mariangelo Cossolini, Cristiano Martini, Adelmo Antonucci, Umberto Cillo, Giacomo Zanus, Umberto Baccarani, Mario Scalamogna, null NITp Liver Transplantation Working
Přispěvatelé: Cardillo, M, De Fazio, N, Pedotti, P, De Feo, T, Fassati, L, Mazzaferro, V, Colledan, M, Gridelli, B, Caccamo, L, Decarlis, L, Valente, U, Andorno, E, Cossolini, M, Martini, C, Antonucci, A, Cillo, U, Zanus, G, Baccarani, U, Scalamogna, M
Rok vydání: 2006
Předmět:
Graft Rejection
Male
Split Liver Transplantation
medicine.medical_treatment
Humans
Liver Transplantation
Whole Liver Transplantation
SLT
North Italian Transplant
NITp
Multicenter Study
Liver transplants
Liver transplantation
Cohort Studies
Postoperative Complications
Medicine
Graft Survival
Middle Aged
Prognosis
Tissue Donors
Treatment Outcome
Italy
Female
Survival Analysi
Human
Cohort study
Adult
medicine.medical_specialty
Tissue and Organ Procurement
Graft failure
Prognosi
Tissue Donor
Risk Assessment
Probability
Proportional Hazards Models
Analysis of Variance
Transplantation
Hepatology
business.industry
Patient survival
Whole liver transplantation
Survival Analysis
Surgery
Split liver transplantation
Proportional Hazards Model
Graft survival
Postoperative Complication
Cohort Studie
business
Liver Failure
Zdroj: Liver Transplantation. 12:402-410
ISSN: 1527-6473
1527-6465
DOI: 10.1002/lt.20720
Popis: A specific split liver transplantation (SLT) program has been pursued in the North Italian Transplant program (NITp) since November 1997. After 5 yr, 1,449 liver transplants were performed in 7 transplant centers, using 1,304 cadaveric donors. Whole liver transplantation (WLT) and SLT were performed in 1, 126 and 323 cases, respectively. SLTs were performed in situ as 147 left lateral segments (LLS), 154 right trisegment liver (RTL) grafts, and 22 modified split livers (MSL), used for couples of adult recipients. After a median posttransplant follow-up of 22 months, SLTs achieved a 3-yr patient and graft survival not significantly different from the entire series of transplants (79.4 and 72.2% vs. 80.6 and 74.9%, respectively). Recipients receiving a WLT or a LLS showed significantly better outcomes than patients receiving RTL and MSL (P < 0.03 for patients and P < 0.04 for graft survival). At the multivariate analysis, donor age of > 60 yr, RTL transplant, < 50 annual transplants volume, urgent transplantation (United Network for Organ Sharing (UNOS) status I and IIA), ischemia time of > 7 hours, and retransplantation were factors independently related to graft failure and to significantly worst patient survival. Right grafts procured from RTL and either split procured as MSL had a similar outcome of marginal whole livers. In conclusion, in 5 yr, the increased number of pediatric transplants due to split liver donation reduced to 3% the in-list children mortality, and a decrease in the adult patient dropout rate from 27.2 to 16.2% was observed. Such results justify a more widespread adoption of SLT protocols, organizational difficulties not being a limit for the application of such technique.
Databáze: OpenAIRE
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