Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Clin Transplant. 2022 Jul;36(7):e14673. doi: 10.1111/ctr.14673. Epub 2022 Apr 26.
Split liver transplantation (SLT) enables two recipients to be transplanted using a single donor liver; typically, an adult and a child. Despite equivalent long-term outcomes to whole grafts in selected adults, the use of these grafts in high-risk adult recipients with high model for end-stage liver disease (MELD) scores (≥30), a poor pre-transplant clinical status (ICU or hospital-bound), acute liver failure or retransplantation remains controversial.
We retrospectively analyzed all deceased donor adult liver transplants performed between July 2002 and November 2019 at a single high-volume center and performed a propensity score-matched analysis. A subgroup analysis was performed to assess utility of these grafts for high-risk recipients.
A total of 1090 adult liver transplants were performed, including 155 SLT (14%). Graft survival at 1-, 3- and 5-years were comparable between recipients of split and whole liver grafts (82%, 79% and 74% vs. 86%, 81% and 77%, respectively, log rank P = .537), as was patient survival at 1-, 3- and 5-years. Recipients of split grafts were more likely to have biliary complications and hepatic artery thrombosis, but equivalent long-term survival. Recipients with high MELD scores or a poor pre-transplant clinical status had similar patient and graft survival and complication profiles irrespective of whether they received split or whole grafts.
SLT is an important method for addressing donor shortages and provides comparable long-term outcomes in adult recipients despite an increase in short-term complications. SLT use in high-risk recipients should be considered to allow for sickest-first allocation policies.
劈离式肝移植（split liver transplantation，SLT）可使单个供肝同时为两名受者进行移植，通常是一名成人和一名儿童。尽管在某些成人中，SLT 的长期效果与全肝移植相当，但在伴有高终末期肝病模型（model for end-stage liver disease，MELD）评分（≥30）、移植前临床状态较差（入住 ICU 或医院）、急性肝衰竭或再次移植的高危成人受者中，使用这些移植物仍然存在争议。
我们回顾性分析了 2002 年 7 月至 2019 年 11 月在一家单中心高容量中心进行的所有成人肝移植，并进行了倾向评分匹配分析。还进行了亚组分析，以评估这些移植物在高危受者中的应用。
共进行了 1090 例成人肝移植，其中 155 例为 SLT（14%）。SLT 组和全肝移植组的 1 年、3 年和 5 年移植物存活率（分别为 82%、79%和 74%和 86%、81%和 77%，log rank P =.537）和患者存活率（分别为 82%、79%和 74%和 86%、81%和 77%，log rank P =.537）相当。SLT 组受者更易发生胆道并发症和肝动脉血栓形成，但长期存活率相当。无论接受 SLT 还是全肝移植，MELD 评分较高或移植前临床状态较差的受者，其患者和移植物存活率以及并发症谱相似。
SLT 是解决供体短缺的重要方法，可为成人受者提供相当的长期效果，尽管短期并发症有所增加。应考虑在高危受者中使用 SLT，以允许实施最需要者优先的分配政策。
