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Survival Outcomes in Split Compared With Whole Liver Transplantation

 Kyung Chul Yoon  ;  Sanghee Song  ;  Eun‐Kyoung Jwa  ;  Sanghoon Lee  ;  Jong Man Kim  ;  Ok‐kyoung Kim  ;  Suk Kyun Hong  ;  Nam‐Joon Yi  ;  Kwang‐Woong Lee  ;  Myoung Soo Kim  ;  Shin Hwang  ;  Kyung‐Suk Suh  ;  Suk‐Koo Lee 
 Liver Transplantation, Vol.24(10) : 1411-1424, 2018 
Journal Title
Issue Date
Adult ; Allografts/anatomy & histology ; Allografts/surgery ; Donor Selection/standards ; End Stage Liver Disease/diagnosis ; End Stage Liver Disease/mortality ; End Stage Liver Disease/surgery* ; Female ; Graft Rejection/epidemiology* ; Graft Survival* ; Humans ; Liver/anatomy & histology ; Liver/surgery ; Liver Transplantation/adverse effects ; Liver Transplantation/methods* ; Liver Transplantation/standards ; Male ; Middle Aged ; Organ Size ; Patient Selection ; Postoperative Complications/epidemiology* ; Postoperative Complications/etiology ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; Survival Rate ; Treatment Outcome
Split-liver transplantation (SLT) should be cautiously considered because the right trisection (RTS) graft can be a marginal graft in adult recipients. Herein, we analyzed the outcomes of RTS-SLT in Korea, where >75% of adult liver transplantations are performed with living donor liver transplantation. Among 2462 patients who underwent deceased donor liver transplantations (DDLTs) from 2005 to 2014, we retrospectively reviewed 86 (3.5%) adult patients who received a RTS graft (RTS-SLT group). The outcomes of the RTS-SLT group were compared with those of 303 recipients of whole liver (WL; WL-DDLT group). Recipient age, laboratory Model for End-Stage-Liver Disease (L-MELD) score, ischemia time, and donor-to-recipient weight ratio (DRWR) were not different between the 2 groups (P > 0.05). However, malignancy was uncommon (4.7% versus 36.3%), and the donor was younger (25.2 versus 42.7 years) in the RST-SLT group than in the WL-DDLT group (P < 0.05). The technical complication rates and the 5-year graft survival rates (89.0% versus 92.8%) were not different between the 2 groups (P > 0.05). The 5-year overall survival (OS) rate (63.1%) and graft-failure-free survival rate (63.1%) of the RTS-SLT group were worse than that of the WL-DDLT group (79.3% and 79.3%; P < 0.05). The factors affecting graft survival rates were not definite. However, the factors affecting OS in the RTS-SLT group were L-MELD score >30 and DRWR ≤1.0. In the subgroup analysis, OS was not different between the 2 groups if the DRWR was >1.0, regardless of the L-MELD score (P > 0.05). In conclusion, a sufficient volume of the graft estimated from DRWR-matching could lead to better outcomes of adult SLTs with a RTS graft, even in patients with high L-MELD scores.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
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