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Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results under the Korean MELD Score-based Allocation Policy

Journal of Korean Medical Science 2020년 35권 37호 p.304 ~ 304
박길춘, 황신, 송기원, 정동환, 하태용, 안철수, 문덕복, 김기헌, 윤영인, 강우형, 조휘동, 최진욱, 김민재, 나병곤, 김상훈, 이승규,
소속 상세정보
박길춘 ( Park Gil-Chun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
황신 ( Hwang Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
송기원 ( Song Gi-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
정동환 ( Jung Dong-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
하태용 ( Ha Tae-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
안철수 ( Ahn Chul-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
문덕복 ( Moon Deok-Bog ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김기헌 ( Kim Ki-Hun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
윤영인 ( Yoon Young-In ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
강우형 ( Kang Woo-Hyoung ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
조휘동 ( Cho Hwui-Dong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
최진욱 ( Choi Jin-Uk ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김민재 ( Kim Min-Jae ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
나병곤 ( Na Byeong-Gon ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김상훈 ( Kim Sang-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
이승규 ( Lee Sung-Gyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Background: Split liver transplantation (SLT) has been occasionally performed in Korea. This study compared the incidence and prognosis of SLT with whole liver transplantation (WLT) in adult patients.

Methods: Between June 2016 and November 2019, 242 adult patients underwent a total of 256 deceased donor liver transplantation operations. SLT was performed in 7 patients (2.9%).

Results: The mean age of SLT donors was 29.7 ± 7.4 years, and the mean age of recipients was 55.7 ± 10.6 years, with the latter having a mean model for end-stage liver disease score of 34.6 ± 3.1. Mean split right liver graft weight was 1,228.6 ± 149.7 g and mean graft-recipient weight ratio was 1.97 ± 0.39. Of the seven SLT recipients, Korean Network for Organ Sharing (KONOS) status was one in status 1, one in status 2 and five in status 3. The graft (P = 0.72) and patient (P = 0.84) survival rates were comparable in the SLT and WLT groups. Following propensity score matching, graft (P = 0.61) and patient (P = 0.91) survival rates remained comparable in the two groups. Univariate analysis showed that pretransplant ventilator support and renal replacement therapy were significantly associated with patient survival, whereas KONOS status category and primary liver diseases were not. Multivariate analysis showed that pretransplant ventilator support was an independent risk factor for patient survival.

Conclusion: Survival outcomes were similar in adult SLT and WLT recipients, probably due to selection of high-quality grafts and low-risk recipients. Prudent selection of donors and adult recipients for SLT may expand the liver graft pool for pediatric patients without affecting outcomes in adults undergoing SLT.

키워드

Deceased Donor; Organ Donor Shortage; Extended Right Liver Graft; Whole Liver Graft

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