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Higher retransplantation rate following extended right split-liver transplantation : an analysis from the Eurotransplant liver follow-up registry

(2018) LIVER TRANSPLANTATION. 24(1). p.26-34
Author
Organization
Abstract
Split-liver transplantation has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant Liver Allocation System (ELAS) envisages that the extended right lobes (ERLs) after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of extended right lobe transplantation (ERLT) in comparison to whole liver transplantation (WLT) recipients remains unclear. Data on all liver transplantations performed between 2007 and 2013 were retrieved from the Eurotransplant Liver Follow-up Registry (n = 5351). Of these, 5013 (269 ERL, 4744 whole liver) could be included. The impact of the transplant type on patient and graft survival was evaluated using univariate and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times were significantly prolonged for ERLTs (P < 0.001). Patient survival was not different between ERLT and WLT. In the univariate analysis, ERLT had a significantly higher risk for retransplantation (P = 0.02). For WLT, the risk for death gradually and significantly increased with laboratory Model for End-Stage Liver Disease (MELD) scores of >20. For ERLT, this effect was seen already with laboratory MELD scores of >14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs. Liver Transplantation 24 26-34 2018 AASLD.
Keywords
WHOLE LIVER, LIVING DONOR, ADULT RECIPIENTS, WAIT-LIST, OUTCOMES, CHILDREN, SURVIVAL

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Chicago
Andrassy, Joachim, Sebastian Wolf, Michael Lauseker, Martin Angele, Marieke D van Rosmalen, Undine Samuel, Xavier Rogiers, Jens Werner, and Markus Guba. 2018. “Higher Retransplantation Rate Following Extended Right Split-liver Transplantation : an Analysis from the Eurotransplant Liver Follow-up Registry.” Liver Transplantation 24 (1): 26–34.
APA
Andrassy, J., Wolf, S., Lauseker, M., Angele, M., van Rosmalen, M. D., Samuel, U., Rogiers, X., et al. (2018). Higher retransplantation rate following extended right split-liver transplantation : an analysis from the Eurotransplant liver follow-up registry. LIVER TRANSPLANTATION, 24(1), 26–34.
Vancouver
1.
Andrassy J, Wolf S, Lauseker M, Angele M, van Rosmalen MD, Samuel U, et al. Higher retransplantation rate following extended right split-liver transplantation : an analysis from the Eurotransplant liver follow-up registry. LIVER TRANSPLANTATION. 2018;24(1):26–34.
MLA
Andrassy, Joachim et al. “Higher Retransplantation Rate Following Extended Right Split-liver Transplantation : an Analysis from the Eurotransplant Liver Follow-up Registry.” LIVER TRANSPLANTATION 24.1 (2018): 26–34. Print.
@article{8600908,
  abstract     = {Split-liver transplantation has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant Liver Allocation System (ELAS) envisages that the extended right lobes (ERLs) after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of extended right lobe transplantation (ERLT) in comparison to whole liver transplantation (WLT) recipients remains unclear. Data on all liver transplantations performed between 2007 and 2013 were retrieved from the Eurotransplant Liver Follow-up Registry (n = 5351). Of these, 5013 (269 ERL, 4744 whole liver) could be included. The impact of the transplant type on patient and graft survival was evaluated using univariate and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times were significantly prolonged for ERLTs (P {\textlangle} 0.001). Patient survival was not different between ERLT and WLT. In the univariate analysis, ERLT had a significantly higher risk for retransplantation (P = 0.02). For WLT, the risk for death gradually and significantly increased with laboratory Model for End-Stage Liver Disease (MELD) scores of {\textrangle}20. For ERLT, this effect was seen already with laboratory MELD scores of {\textrangle}14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs. Liver Transplantation 24 26-34 2018 AASLD.},
  author       = {Andrassy, Joachim and Wolf, Sebastian and Lauseker, Michael and Angele, Martin and van Rosmalen, Marieke D and Samuel, Undine and Rogiers, Xavier and Werner, Jens and Guba, Markus},
  issn         = {1527-6465},
  journal      = {LIVER TRANSPLANTATION},
  language     = {eng},
  number       = {1},
  pages        = {26--34},
  title        = {Higher retransplantation rate following extended right split-liver transplantation : an analysis from the Eurotransplant liver follow-up registry},
  url          = {http://dx.doi.org/10.1002/lt.24980},
  volume       = {24},
  year         = {2018},
}

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