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; Santaniello, W; Zamboni, F; Mazzaferro, V; Rossi, M; Puoti, F; Camagni, S; Grimaldi, C; Gringeri, E; Rizzato, L; Nanni Costa, A; Cillo, U. - 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.
