Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis
Background: Splitting a liver for utilization in adult/pediatric recipients has been shown to decrease mortality on the wait list without increasing the overall risk of long-term graft failure compared to a whole graft. However, splitting a single donor organ for two adult recipients, full-right-ful...
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Shiraz University of Medical Sciences
2016-04-01
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doaj-66c49e74390a4332afa4aceeee4a9f1e2020-11-24T21:53:44ZengShiraz University of Medical SciencesInternational Journal of Organ Transplantation Medicine2008-64822008-64902016-04-0172211Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched AnalysisA Zimmerman0JM Flahive1M Hertl2AB Cosimi3RF Saidi4Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USACenter for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USADivision of Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USATransplantation Unit, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USADivision of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USABackground: Splitting a liver for utilization in adult/pediatric recipients has been shown to decrease mortality on the wait list without increasing the overall risk of long-term graft failure compared to a whole graft. However, splitting a single donor organ for two adult recipients, full-right-full-left split liver transplantation (FRFLSLT), to overcome organ shortage is still considered controversial. Objective: This study assessed the outcome of FRFLSLT comparing full-right (FR) and full-left (FL) with whole liver (WL) allografts in adults (1998–2010) using UNOS standard transplant analysis and research (STAR) file. Methods: Unadjusted allograft and patient survival were estimated using Kaplan-Meier survival curves. Adjusted analyses of survival were conducted controlling for propensity for WL allograft. Results: There were 83,313 cases of WL, 651 FR and 117 FL. Significant differences were evident in the unadjusted cohort between recipients who received FR and FL including donor, cold ischemic time, and days on transplant waiting list. Use of FL allograft resulted in a trend toward lower graft and patient survival compared to WL and FR, which was not statistically significant (p=0.07). In the matched cohort, FL hemiliver allograft had no detrimental effect on the allograft or patient survival after split liver transplantation when compared to FR and WL. Conclusion: After adjusting for donor and recipient characteristics, there was no difference in allograft or patient survival with the use of FL, FR, or WL after liver transplantation in adults. FRFLSLT is a valuable and safe option to expand the donor pool.http://www.ijotm.com/ojs/index.php/IJOTM/article/view/353Liver transplantationWaiting ListsMortalityAllograft survivalPatient survivalSurvival analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
A Zimmerman JM Flahive M Hertl AB Cosimi RF Saidi |
spellingShingle |
A Zimmerman JM Flahive M Hertl AB Cosimi RF Saidi Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis International Journal of Organ Transplantation Medicine Liver transplantation Waiting Lists Mortality Allograft survival Patient survival Survival analysis |
author_facet |
A Zimmerman JM Flahive M Hertl AB Cosimi RF Saidi |
author_sort |
A Zimmerman |
title |
Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis |
title_short |
Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis |
title_full |
Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis |
title_fullStr |
Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis |
title_full_unstemmed |
Outcomes of Full-Right-Full-Left Split Liver Transplantation in Adults in the USA: A Propensity- Score Matched Analysis |
title_sort |
outcomes of full-right-full-left split liver transplantation in adults in the usa: a propensity- score matched analysis |
publisher |
Shiraz University of Medical Sciences |
series |
International Journal of Organ Transplantation Medicine |
issn |
2008-6482 2008-6490 |
publishDate |
2016-04-01 |
description |
Background: Splitting a liver for utilization in adult/pediatric recipients has been shown to decrease mortality on the wait list without increasing the overall risk of long-term graft failure compared to a whole graft. However, splitting a single donor organ for two adult recipients, full-right-full-left split liver transplantation (FRFLSLT), to overcome organ shortage is still considered controversial.
Objective: This study assessed the outcome of FRFLSLT comparing full-right (FR) and full-left (FL) with whole liver (WL) allografts in adults (1998–2010) using UNOS standard transplant analysis and research (STAR) file.
Methods: Unadjusted allograft and patient survival were estimated using Kaplan-Meier survival curves. Adjusted analyses of survival were conducted controlling for propensity for WL allograft.
Results: There were 83,313 cases of WL, 651 FR and 117 FL. Significant differences were evident in the unadjusted cohort between recipients who received FR and FL including donor, cold ischemic time, and days on transplant waiting list. Use of FL allograft resulted in a trend toward lower graft and patient survival compared to WL and FR, which was not statistically significant (p=0.07). In the matched cohort, FL hemiliver allograft had no detrimental effect on the allograft or patient survival after split liver transplantation when compared to FR and WL.
Conclusion: After adjusting for donor and recipient characteristics, there was no difference in allograft or patient survival with the use of FL, FR, or WL after liver transplantation in adults. FRFLSLT is a valuable and safe option to expand the donor pool. |
topic |
Liver transplantation Waiting Lists Mortality Allograft survival Patient survival Survival analysis |
url |
http://www.ijotm.com/ojs/index.php/IJOTM/article/view/353 |
work_keys_str_mv |
AT azimmerman outcomesoffullrightfullleftsplitlivertransplantationinadultsintheusaapropensityscorematchedanalysis AT jmflahive outcomesoffullrightfullleftsplitlivertransplantationinadultsintheusaapropensityscorematchedanalysis AT mhertl outcomesoffullrightfullleftsplitlivertransplantationinadultsintheusaapropensityscorematchedanalysis AT abcosimi outcomesoffullrightfullleftsplitlivertransplantationinadultsintheusaapropensityscorematchedanalysis AT rfsaidi outcomesoffullrightfullleftsplitlivertransplantationinadultsintheusaapropensityscorematchedanalysis |
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