Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Schrem, H; Kleine, M; Lankisch, TO; Kaltenborn, A; Kousoulas, L; Zachau, L; Lehner, F; Klempnauer, J.
Long-term results after adult ex situ split liver transplantation since its introduction in 1987.
World J Surg. 2014; 38(7): 1795-1806.
Doi: 10.1007/s00268-013-2444-4
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- Führende Autor*innen der Med Uni Graz
- Schrem Harald Heinrich
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- Abstract:
- Split liver transplantation is still discussed controversially. Utilization of split liver grafts has been declining since a change of allocation rules for the second graft abolished incentives for German centres to perform ex situ splits. We therefore analysed our long-term experiences with the first ex situ split liver transplant series worldwide. A total of 131 consecutive adult ex situ split liver transplants (01.12.1987-31.12.2010) were analysed retrospectively. Thirty-day mortality rates and 1- and 3-year patient survival rates were 13, 76.3, and 66.4 %, respectively. One- and three-year graft survival rates were 63.4 and 54.2 %, respectively. The observed 10-year survival rate was 40.6 %. Continuous improvement of survival from era 1 to 3 was observed (each era: 8 years), indicating a learning curve over 24 years of experience. Patient and graft survival were not influenced by different combinations of transplanted segments or types of biliary reconstruction (p > 0.05; Cox regression). Patients transplanted for primary sclerosing cholangitis had better survival (p = 0.021; log-rank), whereas all other indications including acute liver failure (13.6 %), acute and chronic graft failure (9.1 %) had no significant influence on survival (p > 0.05; log-rank). Biliary complications (27.4 %) had no significant influence on patient or graft survival (p > 0.05; log-rank). Hepatic artery thrombosis (13.2 %) had a significant influence on graft survival but not on patient survival (p = 0.002, >0.05, respectively; log-rank). Split liver transplantation can be used safely and appears to be an underutilized resource that may benefit from liberal allocation of the second graft.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Anastomotic Leak - etiology
- Cholangitis, Sclerosing - surgery
- Erythrocyte Transfusion -
- Female -
- Graft Survival -
- Hepatic Artery -
- Humans -
- Intraoperative Care -
- Learning Curve -
- Length of Stay -
- Liver Failure, Acute - surgery
- Liver Transplantation - adverse effects
- Liver Transplantation - methods
- Liver Transplantation - mortality
- Male -
- Middle Aged -
- Plasma -
- Portal Vein -
- Reoperation -
- Retrospective Studies -
- Survival Rate -
- Thrombosis - etiology
- Time Factors -