Split liver transplantation with extended right grafts under patient-oriented allocation policy: single center matched-pair outcome analysis

Background: Split liver transplantation (SLT) is an established technique developed to optimize the number of available grafts. Few data are available on SLT with extended right liver grafts (eRLG) in the context of patient-oriented allocation policy. Methods: Between July 1, 2001 and December 31, 2005, 12 whole liver graft (WLG) recipients were matched with 12 eRLG recipients according to their clinical status, indication and year of liver transplantation. Results: There were no differences according to recipient Model for End-stage Liver Disease score, total serum bilirubin, creatinine levels and international normalized ratio in both groups. Fifty percent of donors in eRLG group presented 2 or more extended criteria. Liver transplantation was performed in UNOS status 1/2A in 58% of cases in both groups. Vascular and biliary complications were observed in three patients in the eRLG group. The median follow-up was 25.3 months (range 0.4-63). Early mortality (<= 3 m) was 16.7% in WLG vs. 0% in eRLG, respectively (p = n.s.). Five-yr patient and graft survival rates were 84% and 77%, and 75% and 68%, respectively, for WLG and eRLG. Conclusion: Split liver transplantation with eRLG according to the patient-oriented allocation policy can be performed under emergency or urgent care circumstances with acceptable morbidity and adequate long-term survival