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Inicio Cirugía Española (English Edition) Optimized results of the liver partition program for split-liver transplantation
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Vol. 102. Issue 2.
Pages 84-89 (February 2024)
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Vol. 102. Issue 2.
Pages 84-89 (February 2024)
Original article
Optimized results of the liver partition program for split-liver transplantation
Optimización de los resultados del programa de bipartición hepática para trasplante “split”
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Oriana Barriosa,
Corresponding author
obarrios@bellvitgehospital.cat

Corresponding author.
, Cristina Dopazob, Miguel Angel López-Boadoc, Concepción Gómez-Gavarab, Yiliam Fundora Suarezc, Abiguei Torrentsd, Laura Lladoa
a Departamento de Cirugía HBP y Trasplante Hepático, Hospital Universitari de Bellvitge, Barcelona, Spain
b Departamento de Cirugía HBP y Trasplante Hepático, Hospital Universitari Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
c Departamento de Cirugía HBP y Trasplante Hepático, Hospital Clinic Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
d Organización Catalana de Trasplantes (OCATT), Servicio Catalán de Salud, Cataluña, Spain
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Tables (2)
Table 1. Characteristics of recipients and indication for transplant.
Table 2. Surgical variables and complications.
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Abstract
Introduction

Split liver transplantation is a procedure performed throughout Europe. In 2018 in Catalonia, the distribution of donors was redefined, being potential candidates for SPLIT all those under 35-years and it was made flexible the adult selection for the right graft. The study aim is to evaluate the effect of this modifications on the use of Split donors on the adult/pediatric waiting lists, as well as to evaluate the post-transplant results of adults who received a Split donor.

Methods

Observational and retrospective study; 2 data collection periods "PRE" (2013–2017) and "POST" (2018–2021). The adults recipients results were analyzed by a propensity score matching.

Results

In the first period 3 donors were registered and 3 pediatric patients and 2 adults recieved a transplant. In the POST period, 24 donations with liver bipartition were made, performing the transplant in 19 adults and 24 childrens. When comparing the adults waiting lists, a significant decrease was evidenced, both for adults (p = 0,0001) and on the children's waiting list (p = 0,0004), and up to 3 times there were no recipients on the pediatric waiting list. No significant differences between hospital morbidity or mortality or overall survival were observed in the group of adult recipients of Split grafts.

Conclusions

The flexibility in the selection of the adult recipient and the new distribution of donors makes possible to increase the bipartition rate, reducing the pediatric waiting list without worsening the adults results transplant recipients or their permanence on the waiting list.

Keywords:
Liver transplantation split
Resumen
Introducción

El trasplante hepático “Split” es un procedimiento extendido por toda Europa. En 2018 en Cataluña, se redefinió la distribución de donantes, siendo candidatos potenciales para SPLIT todos aquellos menores de 35 años y se flexibilizó la selección del adulto para el injerto derecho. El objetivo del estudio es evaluar el efecto de estas modificaciones en la utilización de donantes para Split, en las listas de espera y en los resultados de los adultos que recibieron un injerto Split.

Métodos

Estudio observacional y retrospectivo; 2 periodos de recogida de datos “PRE” (2013–2017) y “POST” (2018–2021). Los resultados de los receptores adultos se analizaron mediante un propensity score matching.

Resultados

En el primer período fueron registrados 3 donantes y se trasplantaron 3 pacientes pediátricos y 2 adultos; en el periodo POST se obtuvieron 24 donantes, realizándose el trasplante en 19 adultos y 24 receptores infantiles. Al comparar las listas de espera se evidenció una disminución significativa tanto en la de adultos (p = 0,0001) como en la infantil (p = 0,0004) y hasta en 3 ocasiones no hubo receptores en la lista de espera infantil. No se observaron diferencias significativas en cuanto a morbilidad o mortalidad, ni en la supervivencia global en el grupo de receptores adultos de injertos Split.

Conclusiones

La flexibilidad en la selección del receptor adulto y la nueva distribución de donantes permite aumentar la tasa de bipartición, permitiendo reducir la lista de espera pediátrica sin afectar los resultados en los trasplantados adultos ni su estancia en lista de espera.

Palabras clave:
Trasplante hepático split

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