Department of Surgery, Ludwig-Maximilian University, Munich, Germany.
Institute for Biometrics and Epidemiology, Ludwig-Maximilian University, Munich, Germany.
Liver Transpl. 2018 Jan;24(1):26-34. doi: 10.1002/lt.24980.
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.
劈离式肝移植被认为是增加肝供体的一种重要策略，通过将一个供肝劈分为 2 个移植单位。欧洲器官移植肝分配系统（ELAS）设想，在小儿中心进行劈离后获得的扩大右半肝（ERL）几乎完全转运到第二中心。ELAS 政策是否会影响扩大右半肝移植（ERLT）与全肝移植（WLT）受者的移植物和患者生存率尚不清楚。从欧洲器官移植肝随访登记处（n = 5351）中检索了 2007 年至 2013 年期间进行的所有肝移植的数据。其中，5013 例（269 例 ERL，4744 例全肝）可纳入分析。使用单变量和多变量比例风险模型评估移植类型对患者和移植物生存率的影响，调整供体和受体的人口统计学数据。ERLT 的冷缺血时间明显延长（P < 0.001）。ERLT 和 WLT 的患者生存率无差异。在单变量分析中，ERLT 的再次移植风险显著升高（P = 0.02）。对于 WLT，随着实验室终末期肝病模型评分（MELD）>20，死亡风险逐渐显著增加。对于 ERLT，这一效应在实验室 MELD 评分>14 时已经出现。这些结果需要讨论如何完善劈离政策，以避免 ERL 受者过度的再次移植率，并进一步改善这些原本是最佳供体器官的移植结局。肝脏移植 24 26-34 2018 AASLD。
