Background & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993-2005, 2006-2014, and 2015-2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. Results: SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25-50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. >-10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Conclusions: Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure.

Improving outcomes of in situ split liver transplantation in Italy over the last 25 years

Spada, Marco;De Simone, Paolo;Cardillo, Massimo;Andorno, Enzo
2023-01-01

Abstract

Background & Aims: Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. Methods: The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993-2005, 2006-2014, and 2015-2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. Results: SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included in the analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6 h (p = 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p = 0.009), and transplant centre volumes: 25-50 cases vs. <25 cases (p = 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p = 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6 h (p = 0.007), CIT <6 h vs. >-10 h (p = 0.019), UNOS status 2b (p = 0.038), and UNOS status 3 (p = 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Conclusions: Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure.
2023
Lauterio, Andrea; Cillo, Umberto; Spada, Marco; Trapani, Silvia; De Carlis, Riccardo; Bottino, Giuliano; Bernasconi, Davide; Scalamogna, Chiara; Pinelli, Domenico; Cintorino, Davide; D'Amico, Francesco Enrico; Spagnoletti, Gionata; Miggino, Marco; Romagnoli, Renato; Centonze, Leonardo; Caccamo, Lucio; Baccarani, Umberto; Carraro, Amedeo; Cescon, Matteo; Vivarelli, Marco; Mazaferro, Vincenzo; Ettorre, Giuseppe Maria; Rossi, Massimo; Vennarecci, Giovanni; De Simone, Paolo; Angelico, Roberta; Agnes, Salvatore; Di Benedetto, Fabrizio; Lupo, Luigi Giovanni; Zamboni, Fausto; Zefelippo, Arianna; Patrono, Damiano; Diviacco, Pietro; Laureiro, Zoe Larghi; Gringeri, Enrico; Di Francesco, Fabrizio; Lucianetti, Alessandro; Valsecchi, Maria Grazia; Gruttadauria, Salvatore; De Feo, Tullia; Cardillo, Massimo; De Carlis, Luciano; Colledan, Michele; Andorno, Enzo
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1220998
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