Survival Benefit of Split‐Liver Transplantation for Pediatric and Adult Candidates
Mary G. Bowring, Allan B. Massie, Kathleen B. Schwarz, Andrew M. Cameron, Elizabeth A. King, Dorry L. Segev, Douglas Mogul
Abstract
Patient and graft survival are similar following whole‐liver transplantations (WLTs) versus split‐liver transplantations (SLTs) among pediatric and adult recipients, yet SLTs are rarely used. We sought to determine the survival benefit associated with accepting a splittable graft offer for SLT versus declining and waiting for a subsequent offer using 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) data on 928 pediatric and 1814 adult liver transplantation candidates who were ever offered a splittable graft. We compared eventual mortality, regardless of subsequent transplants, between those patients who accepted versus declined a split liver offer with adjustments for Pediatric End‐Stage Liver Disease/Model for End‐Stage Liver Disease (MELD) scores, diagnosis, and weight among pediatric candidates and matching for MELD score, height, and offer among adult candidates. Among pediatric candidates ≤7 kg, split liver offer acceptance versus decline was associated with a 63% reduction in mortality (adjusted hazard ratio [aHR], 0.17 0.37 0.80 [ P = 0.01]; 93.1% versus 84.0% 1‐year survival after decision). Within 1 year of decline for those ≤7 kg, 6.4% died and 31.1% received a WLT. Among pediatric candidates >7 kg, there was no significant difference associated with acceptance of a split liver offer (aHR, 0.63 1.07 1.82 [ P = 0.81]; 91.7% versus 94.4% 1‐year survival after decision). Within 1 year of decline for those >7 kg, 1.8% died and 45.8% received a WLT. Among adult candidates, split liver offer acceptance was associated with a 43% reduction in mortality (aHR, 0.39 0.57 0.83 [ P = 0.005]; 92.2% versus 84.4% 1‐year survival after decision). Within 1 year of decline for adult candidates, 7.9% died and 39.3% received a WLT. Accepting split liver offers for SLT could significantly improve survival for small children and adults on the waiting list.