Adult-to-Child Split-Liver Transplantation Is a Safe and Effective Way to Meet Demand for Grafts

[Guest guest]

http://www.medscape.com/viewarticle/577501?src=mp & spon=29 & uac=31238BR

Adult-to-Child Split-Liver Transplantation Is a Safe and Effective Way to Meet

Demand for Grafts

DeBusk, PhD

July 14, 2008 (Paris, France) — The review of split-liver transplants conducted

at a large center over a 10-year period has shown that the procedure can be used

to provide grafts for a larger number of patients without sacrificing the

function or survival of the graft or patient.

Vittorio Corno, MD, a surgeon at the Ospedali Riuniti Largo Barozzi Liver and

Lung Transplantation Center, in Bergamo, Italy, presented the results of the

study here at the 2008 Joint International Congress of ILTS, ELITA & LICAGE.

" We started a pediatric liver transplant program back in October 1997, [which

was] followed soon (in 1999) by an adult transplant program, " Dr. Corno told

Medscape Transplantation. " From the beginning we adopted a liberal policy of

splitting [livers for transplant], and we tried to split every splittable liver,

in particular using the standard adult-to-child split procedure. After 10 years

and almost 300 split-liver transplantations performed, we reviewed the results. "

Of 676 liver transplants performed at the center between October 1997 and

October 2007, 247 children and 34 adults received an adult/child split liver

consisting of an extended right graft (12 children, 26 adults) or left lateral

segment (230 children) of the liver, or received an adult/adult split liver (8

adults) consisting of the full right or full left (5 children) portion of the

liver. Dr. Corno and his colleagues compared the outcomes of these transplants

with the outcomes of whole-liver grafts received by 249 adults and 63 children

during the same time period.

Although biliary complications were observed in 295 of the adult patients who

received a split-liver graft, compared with 15% of the adult patients who

received a whole-liver graft (P = .0506), graft survival among adult recipients

of split-liver transplants was higher than graft survival among recipients of

whole grafts at 1 year (88% vs 84%) and at 5 years (85% vs 78%). Patient

survival was also higher among split-liver recipients at 1 year (91% vs 85%) and

at 5 years (88% vs 80%).

The incidence of biliary complications was higher among children who received

split-liver transplants (42% vs 5%; P < .0001), but the complications did not

appear to affect graft or patient survival. Graft survival was higher among

children who received split-liver transplants at 1 year (84% vs 78%) and at 5

years (80% vs 74%), and patient survival was higher among this group at both

time points (1 year, 91% vs. 84%; 5 years, 87% vs 83%).

Dr. Corno acknowledged potential concerns about the common complications of

split-liver transplants in both adults and children, noting that " biliary

complications are significantly higher with partial grafts, both from split

liver and from living donors, " but added that " their incidence does not seem to

have a negative impact on the patient [or on] graft survival. "

Ramsay, MD, secretary and treasurer of the International Liver

Transplantation Society (ILTS), president of the Baylor Research Institute, and

chief of service for the department of anesthesiology and pain management at

Baylor University Medical Center, in Dallas, Texas, told Medscape

Transplantation that the experience at Ospedali Riuniti was successful in

meeting the demand for livers. " The use of split-liver grafts to successfully

increase the number of grafts available, especially for the pediatric waiting

list, is very positive, especially if the survival rates are maintained for both

graft and recipient, " Dr. Ramsay said. " This center demonstrated excellent

results and very successfully expanded the donor pool. "

Dr. Corno suggested that the procedure could be more widely used to meet the

unmet need for organs at major transplant centers. " [The] adult-to-child

split-liver procedure is effective in expanding the organ-donor pool, " Dr. Corno

concluded. " The results are even better than those [obtained] using a whole size

graft, in particular when the procedure is performed by a team from a

high-volume center [that [performs] split-liver transplantation. "

The study did not receive commercial support. Neither Dr. Corno nor Dr. Ramsay

have disclosed any relevant financial relationships.

2008 Joint International Congress of ILTS, ELITA & LICAGE: Abstract 543.

Presented July 11, 2008.

_________________________________________________________________

With Windows Live for mobile, your contacts travel with you.

http://www.windowslive.com/mobile/overview.html?ocid=TXT_TAGLM_WL_mobile_072008

[Guest guest]

http://www.medscape.com/viewarticle/577501?src=mp & spon=29 & uac=31238BR

Adult-to-Child Split-Liver Transplantation Is a Safe and Effective Way to Meet

Demand for Grafts

DeBusk, PhD

July 14, 2008 (Paris, France) — The review of split-liver transplants conducted

at a large center over a 10-year period has shown that the procedure can be used

to provide grafts for a larger number of patients without sacrificing the

function or survival of the graft or patient.

Vittorio Corno, MD, a surgeon at the Ospedali Riuniti Largo Barozzi Liver and

Lung Transplantation Center, in Bergamo, Italy, presented the results of the

study here at the 2008 Joint International Congress of ILTS, ELITA & LICAGE.

" We started a pediatric liver transplant program back in October 1997, [which

was] followed soon (in 1999) by an adult transplant program, " Dr. Corno told

Medscape Transplantation. " From the beginning we adopted a liberal policy of

splitting [livers for transplant], and we tried to split every splittable liver,

in particular using the standard adult-to-child split procedure. After 10 years

and almost 300 split-liver transplantations performed, we reviewed the results. "

Of 676 liver transplants performed at the center between October 1997 and

October 2007, 247 children and 34 adults received an adult/child split liver

consisting of an extended right graft (12 children, 26 adults) or left lateral

segment (230 children) of the liver, or received an adult/adult split liver (8

adults) consisting of the full right or full left (5 children) portion of the

liver. Dr. Corno and his colleagues compared the outcomes of these transplants

with the outcomes of whole-liver grafts received by 249 adults and 63 children

during the same time period.

Although biliary complications were observed in 295 of the adult patients who

received a split-liver graft, compared with 15% of the adult patients who

received a whole-liver graft (P = .0506), graft survival among adult recipients

of split-liver transplants was higher than graft survival among recipients of

whole grafts at 1 year (88% vs 84%) and at 5 years (85% vs 78%). Patient

survival was also higher among split-liver recipients at 1 year (91% vs 85%) and

at 5 years (88% vs 80%).

The incidence of biliary complications was higher among children who received

split-liver transplants (42% vs 5%; P < .0001), but the complications did not

appear to affect graft or patient survival. Graft survival was higher among

children who received split-liver transplants at 1 year (84% vs 78%) and at 5

years (80% vs 74%), and patient survival was higher among this group at both

time points (1 year, 91% vs. 84%; 5 years, 87% vs 83%).

Dr. Corno acknowledged potential concerns about the common complications of

split-liver transplants in both adults and children, noting that " biliary

complications are significantly higher with partial grafts, both from split

liver and from living donors, " but added that " their incidence does not seem to

have a negative impact on the patient [or on] graft survival. "

Ramsay, MD, secretary and treasurer of the International Liver

Transplantation Society (ILTS), president of the Baylor Research Institute, and

chief of service for the department of anesthesiology and pain management at

Baylor University Medical Center, in Dallas, Texas, told Medscape

Transplantation that the experience at Ospedali Riuniti was successful in

meeting the demand for livers. " The use of split-liver grafts to successfully

increase the number of grafts available, especially for the pediatric waiting

list, is very positive, especially if the survival rates are maintained for both

graft and recipient, " Dr. Ramsay said. " This center demonstrated excellent

results and very successfully expanded the donor pool. "

Dr. Corno suggested that the procedure could be more widely used to meet the

unmet need for organs at major transplant centers. " [The] adult-to-child

split-liver procedure is effective in expanding the organ-donor pool, " Dr. Corno

concluded. " The results are even better than those [obtained] using a whole size

graft, in particular when the procedure is performed by a team from a

high-volume center [that [performs] split-liver transplantation. "

The study did not receive commercial support. Neither Dr. Corno nor Dr. Ramsay

have disclosed any relevant financial relationships.

2008 Joint International Congress of ILTS, ELITA & LICAGE: Abstract 543.

Presented July 11, 2008.

_________________________________________________________________

With Windows Live for mobile, your contacts travel with you.

http://www.windowslive.com/mobile/overview.html?ocid=TXT_TAGLM_WL_mobile_072008