Full-left-full-right split liver transplantation for adult recipients: A systematic review and meta-analysis.

BACKGROUND Full-left-full-right split liver transplantation (FSLT) for adult recipients, may increase availability of liver grafts, reduce waitlist time, and benefit recipients with below-average body weight. However, FSLT may lead to impaired graft and patient survival. This study aims to assess outcomes after FSLT. METHODS Five databases were searched to identify studies concerning FSLT. Incidences of complications, graft- and patient survival were assessed. Discrete data were pooled with random-effect models. Graft and patient survival after FSLT were compared to whole liver transplantation (WLT) according to the inverse variance method. RESULTS Vascular complications were reported in 25/273 patients after FSLT (Pooled proportion: 6.9%, 95%CI: 3.1-10.7%, I : 36%). Biliary complications were reported in 84/308 patients after FSLT (Pooled proportion: 25.6%, 95%CI: 19-32%, I : 44%). Pooled proportions of graft and patient survival after 3 years follow-up were 72.8% (95%CI: 67.2-78.5, n=231) and 77.3% (95%CI: 66.7-85.8, n=331), respectively. Compared to WLT, FSLT was associated with increased graft loss (pooled HR: 2.12, 95%CI: 1.24-3.61, P=0.006, n=189) and patient mortality (pooled HR: 1.81, 95%CI: 1.17-2.81, P=0.008, n=289). CONCLUSION FSLT was associated with high incidences of vascular and biliary complications. Nevertheless, long-term patient and graft survival appear acceptable and justify transplant benefit in selected patients