Predictors of survival after in vivo split liver transplantation - Analysis of 110 consecutive patients

Objective To determine the factors that influence patient survival after in vivo split liver transplantation (SLT). Summary Background Data Split liver transplantation is effective in expandi ng the donor pool, and its use reduces the number of deaths in patients awa iting orthotopic liver transplantation. Early SLTs were associated with poo r outcomes, and acceptance of the technique has been slow. A better underst anding of the factors that influence patient and graft survival would be us eful in widening the application of SLT. Methods During a 3.5-year period, 55 right and 55 left lateral in vivo spli t grafts were transplanted in 102 pediatric and adult recipients. The autho rs' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed fo r their effect on patient survival after SLT. Results Overall survival rates of patients who received an SLT were not sig nificantly different from those of patients who received whole organ transp lants. Survival of left lateral segment recipients, at median follow-up tim e, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 pati ents (49%) were high-risk urgent recipients (United Network for Organ Shari ng [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS sta tus 2B, 3). High-risk recipients had a survival rate significantly lower th an that of nonurgent recipients. By univariate comparison, two variables-UN OS status and number of transplants per patient-were significantly associat ed with an increased risk of death. Preoperative recipient mechanical venti lation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance The type of g raft (right vs. left) did not reduce the survival rate after transplantatio n. Multivariate logistic regression analysis identified UNOS status and len gth of donor hospital stay as independent predictors of survival. Conclusions Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation, The variables af fecting outcome of in vivo SLT are similar to those in whole-organ transpla ntation, in vivo SLT should be widely ap plied to expand a severely deplete d donor pool.