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Adult Split Liver Transplants Increased after Implementation of a Pediatric Liver Transplant Program

J. Cullen1, P. Vargas1, S. Pelletier1, K. Soltys2, S. Rasmussen1, G. Mazariegos2, J. Oberholzer1, N. Goldaracena1

1Surgery, University of Virginia, Charlottesville, VA, 2Surgery, University of Pittsburgh, Pittsburgh, PA

Meeting: 2020 American Transplant Congress

Abstract number: C-156

Keywords: Pediatric, Split-liver transplantation

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session C: Liver: Living Donors and Partial Grafts

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

Related Abstracts
  • Split Liver Transplantation in a Combined Adult/Pediatric Transplant Program
  • Time for the Grown Ups to Split the Difference? Outcomes of Two Adult Split Liver Transplants in the USA.

*Purpose: Split liver transplantation (SLT) is a strategy to address organ shortage, but is technically more demanding than whole liver transplants.

*Methods: SLTs conducted at a single-center from 2010-2019 were identified, and patient data was obtained through retrospective review of the electronic medical record. Kaplan-Meier analysis assessed primary outcomes of 1-year graft and patient survival.

*Results: Thirty-seven SLTs occurred during the study period. Twenty-four deceased donors donated 21 right lobes for an adult recipient and 16 left lateral segment (LLS) grafts for a pediatric recipient. 16/24 (67%) donors were pediatric donors (age<18). Among the pediatric donors, median age was 16 (13-17) years. Among adult donors, median age was 27 (19-36). Recipient data is displayed in Table 1. Among the pediatric recipients median PELD score was 45 (8-53) and 6 patients were status 1b on the list. In total, 81% (30/37) SLTs were performed after the introduction of the pediatric program in 2016. Thirteen donor livers were split with both grafts allocated and used at our center: the LLS used for a pediatric recipient and the right lobe for an adult, resulting in 26/37 transplants (70.3%). Twelve (92%) of these splits (24 SLTs) occurred after the introduction of the pediatric program in 2016. Median follow-up was 548 (10-3145) days. Of the 24 recipients with at least 1-year follow-up, graft and patient survival were 96% and 100%, respectively.

*Conclusions: The introduction of a pediatric liver transplant program resulted in more than a 4-fold increase in the number of SLTs performed at our center. Both split grafts from a single donor whole liver were allocated and used at our center, accounting for 26 of the 37 overall SLTs. Of those 26, 13 were performed in adults with excellent results. Moreover, pediatric SLT were performed in patients with high status achieving 100% graft and patient survival with zero waitlist mortality.

Clinical characteristics and outcomes among recipients
Pediatric Recipients (n=16) Adult Recipients (n=21)
Age 2 (0-5) 59 (21-69)
Female 63% (10) 62% (13)
Waitlist Days 89 (15-162) 103 (1-1662)
P/MELD at Transplant 45 (8-53); Status 1B (6) 23 (8-37)
ICU Stay 9.3 (1-89) 1.7 (1-7)
Bile Duct Stricture 13% (2) 15% (3)
Median Patient Survival 543 days 627 days

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To cite this abstract in AMA style:

Cullen J, Vargas P, Pelletier S, Soltys K, Rasmussen S, Mazariegos G, Oberholzer J, Goldaracena N. Adult Split Liver Transplants Increased after Implementation of a Pediatric Liver Transplant Program [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/adult-split-liver-transplants-increased-after-implementation-of-a-pediatric-liver-transplant-program/. Accessed February 28, 2021.

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