Methods:

Analysis of long term outcomes of 194 consecutive left lateral segment grafts (LLS) including 94 living (LD) and 99 deceased (DD) donor grafts (1992 – 2017) with mean follow-up of 8.8±6.7 years was conducted. Comparison of recipient, donor, and operative characteristics were performed. Kaplan-Meier analysis used to compare overall patient/graft survival at 1, 5, and 10 years.

Results:

Primary diagnosis was biliary atresia (53%), metabolic disorders (15%), fulminant liver failure (8%), and malignancy (8%). Wait time from listing until transplant was 102±337 days for LD and 122±261 days for DD (p=0.67). Age at transplant was not significantly different at 2.0±2.2 years versus 2.4±2.6 years for LD and DD respectively (p=0.21). Warm and cold ischemia times were lower in the LD group (42±16 mins, 98±143 min) compared DD group (48±22 mins, 474±175 mins) (p<0.001). Donor liver mass was lower for living donor recipients (262±89g v.302±93g) (p=0.045). Significanlty more deceased donors were used for retransplantation. Biliary complications occurred in 11% (LD) vs. 14% (DD) (p=0.51). Hepatic artery (HAT) and portal venous thrombosis (PVT) rates were higher in the DD group (7% and 5% LD group (p=0.05,0.5) vs. 16% and 8% DD group (p=0.05,0.5)) The 1, 5, and 10 year graft survival was 91%, 88%, 85% for the LD group and 81%, 74%, 66% for the DD group (p=0.001). The overall patient survival at 1, 5, 10 years was 92%, 89%, 87% for the LD group vs. and 81%, 77%, 74% for the DD group (p=0.021).

Conclusion:

Use of split grafts remains a viable option to meet the needs of the pediatric liver failure population with excellent long term outcomes. Our analysis shows improved graft and patient survival with living donor grafts.

CITATION INFORMATION: Adamson D., Tabrizian P., Parides M., Iyer K., Moon J., Chu J., Arnon R., Florman S. Outcomes from 194 Consecutive Split Left Liver Transplants: Comparison of Living versus Deceased Donors Am J Transplant. 2017;17 (suppl 3).

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