Accepting split liver transplant linked with lower mortality

Accepting grafts for a split liver transplantation may improve survival for smaller children and adults on the waitlist, according to research presented at the Liver Meeting Digital Experience.

In her presentation, Mary Grace Bowring, an MD/PhD candidate at Johns Hopkins, said that outcomes following split and whole liver transplantation are comparable. However, split liver transplants make only a small portions of total liver transplants.

“If faced with simultaneous offers of split vs. a whole liver while on the waitlist for an adult or pediatric candidate, the decision might be clear, but this is rarely the case” she said. “Patients are more likely to face a decision to accept a splitable offer today or to decline that offer and wait for something else to come along.”

Researchers analyzed data from the 2010-2018 Scientific Registry for Transplant Recipients to determine the survival benefit of accepting a split liver compared with declining it and waiting for another offer. Their analysis included data on 928 pediatric patients and 7,906 adults.

In their pediatric analysis, researchers compared patient survival between candidates who accepted (n = 617) vs. those who ever declined (n = 381) split liver offers. In adults, they compared patient survival between adult candidates who accepted (n = 358) split liver offers with those who declined the same split liver offer (n = 8,252).

Among pediatric patients who weighed no more than 7 kg, accepting a split liver transplant was associated with a 63% reduction in mortality compared with decline (adjusted HR = 0.37; 93.1% vs. 84% 1-year survival post-decision). Within 1 year of decline, 6.4% of patients died and 31.1% received a whole liver transplant. In pediatric patients who weighed more than 7 kg, researchers found no significant difference associated with acceptance of a split liver transplant.

Among adult patients, split liver transplant acceptance was associated with a 43% reduction in mortality (aHR = 0.57; 92.2% vs. 84.4% 1-year survival post-decision). In the year after decline, 7.9% of adult patients died and 39.3% received a whole liver transplant.

“This provides further evidence to support that increasing the national volume of split liver transplant performed annually,” Bowring said. “Given the survival benefit we observed and the size-mismatch problems that smaller adults consistently face, we argue that the candidate pool most often considered for the right tri-segment might need to be expanded.”