• Annals of surgery · Jun 2024

    Right Ex-situ split grafts for adult liver transplantation - A Multicenter Benchmarking Analysis.

    • Natacha Boulanger, Xavier Muller, Federica Dondero, Nicolas Golse, Claire Goumard, Antoine Breton, Ailton Sepulveda, Marc-Antoine Allard, Eric Savier, Safi Dokmak, Gabriella Pittau, Oriana Ciacio, Chady Salloum, Fabiano Perdigão, Géraldine Rousseau, Chetana Lim, Guillaume Rossignol, Eric Vibert, Sa CunhaAntonioADepartment of Hepatobiliary Surgery and Transplantation, APHP, Paul Brousse Hospital, University of Paris Sud, Villejuif, France., Kayvan Mohkam, Daniel Azoulay, René Adam, Olivier Scatton, Mickael Lesurtel, Daniel Cherqui, Olivier Soubrane, and Jean Yves Mabrut.
    • Department of Surgery and Liver Transplantation, Croix-Rousse University Hospital, University of Lyon I, Lyon, France.
    • Ann. Surg. 2024 Jun 18.

    ObjectiveTo analyse outcomes after adult right ex-situ split graft liver transplantations (RSLT) and compare with available outcome benchmarks from whole liver transplantation (WLT).Summary Background DataEx-situ SLT may be a valuable strategy to tackle the increasing graft shortage. Recently established outcome benchmarks in WLT offer a novel reference to perform a comprehensive analysis of results after ex-situ RSLT.MethodsThis retrospective multicenter cohort study analyzes all consecutive adult SLT performed using right ex-situ split grafts from 01.01.2014 to 01.06.2022. Study endpoints included 1 year graft and recipient survival, overall morbidity expressed by the comprehensive complication index (CCI©) and specific post-LT complications. Results were compared to the published benchmark outcomes in low-risk adult WLT scenarii.ResultsIn 224 adult right ex-situ SLT, 1y recipient and graft survival rates were 96% and 91.5%, within the WLT benchmarks. The 1y overall morbidity was also within the WLT benchmark (41.8 CCI points vs. <42.1). Detailed analysis, revealed cut surface bile leaks (17%, 65.8% Grade IIIa) as a specific complication without a negative impact on graft survival. There was a higher rate of early hepatic artery thrombosis (HAT) after SLT, above the WLT benchmark (4.9% vs. ≤4.1%), with a significant impact on early graft but not patient survival.ConclusionIn this multicentric study of right ex-situ split graft LT, we report 1-year overall morbidity and mortality rates within the published benchmarks for low-risk WLT. Cut surface bile leaks and early HAT are specific complications of SLT and should be acknowledged when expanding the use of ex-situ SLT.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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