Higher Retransplantation rate following Extended Right Split-Liver Transplantation - An analysis from the Eurotransplant Liver follow-up Registry

Split liver transplantation (SLT) has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant allocation system (ELAS) envisages that the ERLs after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of ERLT in comparison to WLT recipients remains unclear. Data on all LTs performed between 2007 and 2013 were retrieved from the ET Liver follow-up Registry (n=5351). Data on n=5013 (269 ERL, 4744 WL) could be included. The impact of the transplant type on patient and graft survival was evaluated using uni- and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times (CIT) were significantly prolonged for ERLTs (p 20. For ERLT this effect was seen already with labMELD scores of >14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs. This article is protected by copyright. All rights reserved.