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Encouraging Split Liver Transplantation for Two Adult Recipients to Mitigate the High Incidence of Wait-list Mortality in The Setting of Extreme Shortage of Deceased Donors

Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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J. Clin. Med. 2019, 8(12), 2095; https://doi.org/10.3390/jcm8122095
Received: 7 October 2019 / Revised: 3 November 2019 / Accepted: 26 November 2019 / Published: 1 December 2019
(This article belongs to the Special Issue Liver Transplantation)
Background: Organ demand for liver transplantation (LT) is constantly increasing. Split liver transplantation (SPLT) is an ideal option for increasing the number of available liver grafts for transplantation and ameliorating organ shortage to a certain degree. However, SPLT for two adult recipients is still not broadly applied. Methods: We retrospectively analyzed the outcomes of SPLT for adult recipients at a single center. All donor, recipient, and transplantation factors were thoroughly investigated to clarify factors affecting patient outcomes after LT. Results: One hundred consecutive adult SPLTs were performed during the study period. Early mortality and 1-year mortality occurred in 21 and 31 recipients, respectively. On multivariate analysis, graft weight (p = 0.036, odds ratio = 0.99, 95% confidence interval = 0.98–0.99) was the independent risk factor associated with early mortality; however, no factor was significantly related to 1-year mortality. On receiver operating characteristic curve analysis, a graft weight of 580 g was identified the cutoff for stratifying outcomes. Recipients transplanted with a graft weighing ≥580 g had significantly better outcome as compared with other recipients (p = 0.001). Moreover, SPLT remarkably provided a better survival benefit for recipients than those on the LT wait-list (p < 0.0001). Conclusions: Given the considerable incidence of wait-list mortality, SPLT for two adult recipients should be encouraged whenever possible to increase the donor pool and benefit patients awaiting LT. Nonetheless, caution should be taken with a smaller graft weight owing to the risk of early graft loss.
Keywords: split liver transplantation; adult recipient; graft weight; risk factor; outcome split liver transplantation; adult recipient; graft weight; risk factor; outcome
MDPI and ACS Style

Chan, K.-M.; Wang, Y.-C.; Wu, T.-H.; Cheng, C.-H.; Lee, C.-F.; Wu, T.-J.; Chou, H.-S.; Lee, W.-C. Encouraging Split Liver Transplantation for Two Adult Recipients to Mitigate the High Incidence of Wait-list Mortality in The Setting of Extreme Shortage of Deceased Donors. J. Clin. Med. 2019, 8, 2095.

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