Predictors of survival after in vivo split liver transplantation

Analysis of 110 consecutive patients

Rafik M. Ghobrial, Hasan Yersiz, Douglas G. Farmer, Farin Amersi, John Goss, Pauline Chen, Sherfield Dawson, Susan Lerner, Nicholas Nissen, David Imagawa, Steven D Colquhoun, Walid Arnout, Sue V. McDiarmid, Ronald W. Busuttil

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective. To determine the factors that influence patient survival after in vivo split liver transplantation (SLT). Summary Background Data. Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT. Methods. During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT. Results. Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 patients (49%) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables - UNOS status and number of transplants per patient - were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival. Conclusions. Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation, in vivo SLT should be widely applied to expand a severely depleted donor pool.

Original languageEnglish (US)
Pages (from-to)312-323
Number of pages12
JournalAnnals of Surgery
Volume232
Issue number3
DOIs
StatePublished - Sep 18 2000
Externally publishedYes

Fingerprint

Liver Transplantation
Survival
Tissue Donors
Transplants
Length of Stay
Survival Rate
Warm Ischemia
Prothrombin Time
Organ Transplantation
Graft Survival
Artificial Respiration
Transplantation
Logistic Models
Sodium
Regression Analysis
Pediatrics

ASJC Scopus subject areas

  • Surgery

Cite this

Ghobrial, R. M., Yersiz, H., Farmer, D. G., Amersi, F., Goss, J., Chen, P., ... Busuttil, R. W. (2000). Predictors of survival after in vivo split liver transplantation: Analysis of 110 consecutive patients. Annals of Surgery, 232(3), 312-323. https://doi.org/10.1097/00000658-200009000-00003

Predictors of survival after in vivo split liver transplantation : Analysis of 110 consecutive patients. / Ghobrial, Rafik M.; Yersiz, Hasan; Farmer, Douglas G.; Amersi, Farin; Goss, John; Chen, Pauline; Dawson, Sherfield; Lerner, Susan; Nissen, Nicholas; Imagawa, David; Colquhoun, Steven D; Arnout, Walid; McDiarmid, Sue V.; Busuttil, Ronald W.

In: Annals of Surgery, Vol. 232, No. 3, 18.09.2000, p. 312-323.

Research output: Contribution to journalArticle

Ghobrial, RM, Yersiz, H, Farmer, DG, Amersi, F, Goss, J, Chen, P, Dawson, S, Lerner, S, Nissen, N, Imagawa, D, Colquhoun, SD, Arnout, W, McDiarmid, SV & Busuttil, RW 2000, 'Predictors of survival after in vivo split liver transplantation: Analysis of 110 consecutive patients', Annals of Surgery, vol. 232, no. 3, pp. 312-323. https://doi.org/10.1097/00000658-200009000-00003
Ghobrial, Rafik M. ; Yersiz, Hasan ; Farmer, Douglas G. ; Amersi, Farin ; Goss, John ; Chen, Pauline ; Dawson, Sherfield ; Lerner, Susan ; Nissen, Nicholas ; Imagawa, David ; Colquhoun, Steven D ; Arnout, Walid ; McDiarmid, Sue V. ; Busuttil, Ronald W. / Predictors of survival after in vivo split liver transplantation : Analysis of 110 consecutive patients. In: Annals of Surgery. 2000 ; Vol. 232, No. 3. pp. 312-323.
@article{276ccb98aa194e1e8718cc692ed8f98d,
title = "Predictors of survival after in vivo split liver transplantation: Analysis of 110 consecutive patients",
abstract = "Objective. To determine the factors that influence patient survival after in vivo split liver transplantation (SLT). Summary Background Data. Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT. Methods. During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT. Results. Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76{\%} versus 80{\%} in patients receiving a trisegment. Fifty of 102 patients (49{\%}) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51{\%}) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables - UNOS status and number of transplants per patient - were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival. Conclusions. Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation, in vivo SLT should be widely applied to expand a severely depleted donor pool.",
author = "Ghobrial, {Rafik M.} and Hasan Yersiz and Farmer, {Douglas G.} and Farin Amersi and John Goss and Pauline Chen and Sherfield Dawson and Susan Lerner and Nicholas Nissen and David Imagawa and Colquhoun, {Steven D} and Walid Arnout and McDiarmid, {Sue V.} and Busuttil, {Ronald W.}",
year = "2000",
month = "9",
day = "18",
doi = "10.1097/00000658-200009000-00003",
language = "English (US)",
volume = "232",
pages = "312--323",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Predictors of survival after in vivo split liver transplantation

T2 - Analysis of 110 consecutive patients

AU - Ghobrial, Rafik M.

AU - Yersiz, Hasan

AU - Farmer, Douglas G.

AU - Amersi, Farin

AU - Goss, John

AU - Chen, Pauline

AU - Dawson, Sherfield

AU - Lerner, Susan

AU - Nissen, Nicholas

AU - Imagawa, David

AU - Colquhoun, Steven D

AU - Arnout, Walid

AU - McDiarmid, Sue V.

AU - Busuttil, Ronald W.

PY - 2000/9/18

Y1 - 2000/9/18

N2 - Objective. To determine the factors that influence patient survival after in vivo split liver transplantation (SLT). Summary Background Data. Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT. Methods. During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT. Results. Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 patients (49%) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables - UNOS status and number of transplants per patient - were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival. Conclusions. Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation, in vivo SLT should be widely applied to expand a severely depleted donor pool.

AB - Objective. To determine the factors that influence patient survival after in vivo split liver transplantation (SLT). Summary Background Data. Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT. Methods. During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT. Results. Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 patients (49%) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables - UNOS status and number of transplants per patient - were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival. Conclusions. Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation, in vivo SLT should be widely applied to expand a severely depleted donor pool.

UR - http://www.scopus.com/inward/record.url?scp=0033840386&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033840386&partnerID=8YFLogxK

U2 - 10.1097/00000658-200009000-00003

DO - 10.1097/00000658-200009000-00003

M3 - Article

VL - 232

SP - 312

EP - 323

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -