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Expansion of the Liver Donor Supply Through Greater Use of Split‐Liver Transplantation: Identifying Optimal Recipients
Douglas B. Mogul
Xun Luo
Jacqueline Garonzik‐Wang
Mary G. Bowring
Allan B. Massie
Kathleen B. Schwarz
Andrew M. Cameron
John F. P. Bridges
Dorry L. Segev
First published: 19 September 2018
https://doi.org/10.1002/lt.25340
Dorry L. Segev has financial relationships from Novartis and Sanofi. Kathleen B. Schwarz has financial relationships with Gilead, Bristol‐Meyers Squibb, Roche, and Up to Date.
Douglas B. Mogul is supported by grant number 5K08HS023876‐02 from the Agency for Healthcare Research and Quality. Dorry L. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases. Allan B. Massie is supported by grant number K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases.
The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of, or interpretation by, the SRTR or the US government.
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Abstract
The increased use of split‐liver transplantation (SLT) represents a strategy to increase the supply of organs. Although outcomes after SLT and whole liver transplantation (WLT) are similar on average among pediatric recipients, we hypothesized that the relationship between graft type and outcomes may vary depending on patient, donor, and surgical characteristics. We evaluated graft survival among pediatric (<18 years) deceased donor, liver‐only transplant recipients from March 2002 until December 2015 using data from the Scientific Registry of Transplant Recipients. Graft survival was assessed in a Cox proportional hazards model, with and without effect modification between graft type and donor, recipient, and surgical characteristics, to identify conditions where the risk of graft loss for SLT and WLT were similar. In a traditional multivariable model, characteristics associated with graft loss included donor age >50 years, recipient weight <10 kg, acute hepatic necrosis, autoimmune diseases, tumor, public insurance, and cold ischemia time (CIT) >8 hours. In an analysis that explored whether these characteristics modified the relationship between graft type and graft loss, many characteristics associated with loss actually had similar outcomes regardless of graft type, including weight <10 kg, acute hepatic necrosis, autoimmune diseases, and tumor. In contrast, several subgroups had worse outcomes when SLT was used, including recipient weight 10‐35 kg, non–biliary atresia cholestasis, and metabolic disease. Allocation score, share type, or CIT did not modify risk of graft type and graft failure. Although one might anticipate that individuals with higher rates of graft loss would be worse candidates for SLT, data suggest that these patients actually have similar rates of graft loss. These findings can guide surgical decision making and may support policy changes that promote the increased use of SLT for specific pediatric recipients.
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发表于 2019-9-9 17:59