To implement split liver transplantation(SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard-risk are offered for SLT, resulting in a left-lateral segment(LLS) graft for children and an extended-right graft(ERG) for adults. We aim to analyse the impact of the new mandatory-split policy on liver transplantation(LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015-December 2016 out of 413 potentially "splittable" donors, 252(61%) were proposed for SLT, of whom 53(21%) donors were accepted for SLT while 101(40.1%) were excluded because of donor characteristics and 98(38.9%) for absence of suitable paediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8%(p=0.009) and the paediatric LT-waiting list time dropped [229(10-2121) vs. 80(12-2503) days(p=0.045)]. The paediatric [4.5% vs. 2.5%(p=0.398)] and adult [9.7% to 5.2%(p<0.001)] LT-waiting list mortality reduced; SLT outcomes remained stable. Re-transplantation(HR=2.641, p=0.035) and recipient weight >20kg(HR=5.113, p=0.048) in LLS, and ischemic time >8hours(HR=2.475,p=0.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favourable impact on the paediatric LT-waiting list and priority for adult sick LT candidates. This article is protected by copyright. All rights reserved.
A National Mandatory-Split Liver Policy: A Report from the Italian Experience / Angelico, R., Trapani, S., Spada, M., Colledan, M., de Ville de Goyet, J., Salizzoni, M., De Carlis, L., Andorno, E., Gruttadauria, S., Ettorre, G.M., Cescon, M., Rossi, G., Risaliti, A., Tisone, G., Tedeschi, U., Vivarelli, M., Agnes, S., De Simone, P., Lupo, L.G., Di Benedetto, F., et al.. - In: AMERICAN JOURNAL OF TRANSPLANTATION. - ISSN 1600-6135. - (2019). [10.1111/ajt.15300]
A National Mandatory-Split Liver Policy: A Report from the Italian Experience
Vivarelli, M;De Simone, P;Rossi, M;Puoti, F;
2019
Abstract
To implement split liver transplantation(SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard-risk are offered for SLT, resulting in a left-lateral segment(LLS) graft for children and an extended-right graft(ERG) for adults. We aim to analyse the impact of the new mandatory-split policy on liver transplantation(LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015-December 2016 out of 413 potentially "splittable" donors, 252(61%) were proposed for SLT, of whom 53(21%) donors were accepted for SLT while 101(40.1%) were excluded because of donor characteristics and 98(38.9%) for absence of suitable paediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8%(p=0.009) and the paediatric LT-waiting list time dropped [229(10-2121) vs. 80(12-2503) days(p=0.045)]. The paediatric [4.5% vs. 2.5%(p=0.398)] and adult [9.7% to 5.2%(p<0.001)] LT-waiting list mortality reduced; SLT outcomes remained stable. Re-transplantation(HR=2.641, p=0.035) and recipient weight >20kg(HR=5.113, p=0.048) in LLS, and ischemic time >8hours(HR=2.475,p=0.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favourable impact on the paediatric LT-waiting list and priority for adult sick LT candidates. This article is protected by copyright. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
