Faculty Collaboration Database

Intention to Split Policy: A Successful Strategy in a Combined Pediatric and Adult Liver Transplant Center. Ann Surg 2017 May;265(5):1009-1015

Date

06/04/2016

Pubmed ID

27257738

DOI

10.1097/SLA.0000000000001816

Scopus ID

2-s2.0-84973529694 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

OBJECTIVE: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an "intention to split policy."

BACKGROUND: SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.

METHODS: Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.

RESULTS: Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of "intention to split policy" resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.

CONCLUSIONS: SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.

Author List

Battula NR, Platto M, Anbarasan R, Perera MT, Ong E, Roll GR, Ferraz Neto BH, Mergental H, Isaac J, Muiesan P, Sharif K, Mirza DF

Author

Narendra Battula MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Adult
Age Factors
Child
Child, Preschool
Cohort Studies
Databases, Factual
Graft Rejection
Graft Survival
Health Policy
Humans
Kaplan-Meier Estimate
Liver Transplantation
Policy Making
Proportional Hazards Models
Retrospective Studies
Survival Rate
Tissue Donors
Tissue and Organ Procurement
Treatment Outcome
United Kingdom
Waiting Lists