Paiano Lucia, Azoulay Daniel, Blandin Frédérique, Allard Marc-Antoine, Pietrasz Daniel, Ciacio Oriana, Pittau Gabriella, Salloum Chady, De Martin Eleonora, Sa Cunha Antonio, Adam René, Cherqui Daniel, Vibert Eric, Golse Nicolas
Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France.
Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France; Inserm, Université Paris-Saclay, UMRS 1193, Physio Pathogénèse et Traitement des Maladies du foie, FHU Hepatinov, 94800, Villejuif, France.
HPB (Oxford). 2025 Jul;27(7):899-909. doi: 10.1016/j.hpb.2025.03.004. Epub 2025 Mar 10.
Split liver transplantation (SLT) from deceased donors is a potential solution to the global organ shortage. While effective in patients with mild disease, outcomes in high MELD score recipients remain uncertain and conflicting. This study compares survival in high vs. low MELD score recipients.
This retrospective single-centre study included all consecutive patients transplanted with a split liver graft between 2010 and 2022. Two groups of recipients with MELD<25 and ≥ 25 at LT were compared.
The study population included 119 patients (n = 98 with MELD<25, n = 21 with MELD≥25) with an average follow-up of 55 months. Both groups were comparable in terms of indication for transplantation and donor characteristics. The high MELD group required more blood transfusions (7 vs. 3 units; p < 0.001) during LT and had a longer stay in intensive care unit (7 vs. 5 days; p = 0.011). Biliary, arterial, and venous complications were similar between groups, as well as graft survival (5 years: 75 % vs. 61 %, p = 0.35) and long-term overall survival (5 years: 83 % vs. 75 %, p = 0.17).
Our results indicate that SLT for patients with MELD≥25 improves access to grafts, is feasible and safe, without significant increased risk of severe complications or decreased long-term overall patient or graft survivals.
来自已故供体的劈离式肝移植（SLT）是解决全球器官短缺问题的一种潜在方法。虽然对轻症患者有效，但高终末期肝病模型（MELD）评分受者的移植结局仍不确定且存在争议。本研究比较了高MELD评分与低MELD评分受者的生存率。
这项回顾性单中心研究纳入了2010年至2022年间所有接受劈离式肝移植的连续患者。比较了两组肝移植时MELD<25和≥25的受者。
研究人群包括119例患者（MELD<25的患者98例，MELD≥25的患者21例），平均随访55个月。两组在移植指征和供体特征方面具有可比性。高MELD组在肝移植期间需要更多的输血（7单位对3单位；p<0.001），在重症监护病房的停留时间更长（7天对5天；p=0.011）。两组之间的胆道、动脉和静脉并发症相似，移植物存活率（5年：75%对61%，p=0.35）和长期总生存率（5年：83%对75%，p=0.17）也相似。
我们的结果表明，对MELD≥25的患者进行劈离式肝移植可改善移植物的可及性，是可行且安全的，不会显著增加严重并发症的风险，也不会降低患者或移植物的长期总生存率。
