Skip to main content

Advertisement

SpringerLink
Log in

Split versus living-related adult liver transplantation: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background-objective

The outcomes of split liver transplantation between recipients of deceased donor split liver transplant (SLT) or live donor liver transplants (LDLT) have never been compared in meta-analysis. It is important to understand graft and recipient survival between recipients of these grafts.

Methods

Databases were searched for relevant articles over the previous 20 years (MEDLINE, Embase, Cochrane Library and Google Scholar). Meta-analyses were performed using both fixed- and random-effects models. Patient survival and graft survival were obtained using the inverse variance hazard ratio method.

Results

There were differences in the characteristics of the donors and recipients. Donors of the SLT were younger compared to LDLT cohort [mean difference (MD) = − 11.12 years (− 15.41 to − 6.84), p < 0.001] whilst recipients of LDLT were younger [MD = − 2.06 years (− 1.12 to − 3.01), p < 0.001]. Significantly fewer men received grafts after SLT, 45%, compared to those receiving LDLT, 55%, [OR = 0.66 (0.55 to 0.80), p < 0.001]. There were no significant differences detected in postoperative complications, graft and patient 1-, 3- and 5-year survival between the SLT and LDLT cohorts.

Conclusions

There is no apparent difference in overall survival, graft survival or complications between recipients of SLT or LDLT. However, characteristics of the donor and recipients differed suggesting the need for adequate risk-adjusted assessment of outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bismuth H, Houssin D (1984) Reduced-size orthotopic liver graft in hepatic transplantation in children. Surgery 95:367–370

    CAS  PubMed  Google Scholar 

  2. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H (1988) Transplantation of a donor liver to 2 recipients (splitting transplantation) a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir 373:127–130

    Article  CAS  PubMed  Google Scholar 

  3. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA (1990) Successful liver transplantation from a living donor to her son. N Engl J Med 322:1505–1507

    Article  CAS  PubMed  Google Scholar 

  4. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  5. Higgins JPT, Green S, ends. (2006) Cochrane handbook for systematic reviews of interventions Chichester, UK: John Willey& Son Ltd. The Cochrane library Issue 4

  6. Hozo SP, Diulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  7. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834

    Article  CAS  PubMed  Google Scholar 

  8. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected with simple graphical test. BMJ (Clin Res Ed) 315(7109):629–634

    Article  CAS  Google Scholar 

  9. Giacomoni A, De Carlis L, Lauterio A, Slim AO, Aseni P, Sammartino I et al (2005) Right hemiliver transplant: results from living and cadaveric donors. Transplant Proc 37:1167–1169

    Article  CAS  PubMed  Google Scholar 

  10. Sebagh M, Yilmaz F, Karam V, Falissard B, Ichai P, Roche B et al (2006) Cadaveric full-size liver transplantation and the graft alternatives in adults: a comparative study from a single Centre. J Hepatol 44:118–125

    Article  PubMed  Google Scholar 

  11. Humar A, Beissel J, Crotteau S, Kandaswamy R, Lake J, Payne W (2008) Whole liver versus split liver versus living donor in the adult recipient: an analysis of outcomes by graft type. Transplantation 85:1420–1424

    Article  PubMed  Google Scholar 

  12. Saidi RF, Jabbour N, Li YF, Shah SA, Bozorgzadeh A (2011) Outcomes in partial liver transplantation: deceased donor split-liver vs live donor liver transplantation. HPB(Oxford) 13:797–801

    Google Scholar 

  13. Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559

    Article  Google Scholar 

  14. Washburn K, Halff G, Mieles L, Goldstein R, Goss JA (2005) Split-liver transplantation: results of statewide usage of the right trisegmental graft. Am J Transplant 5:1652–1659

    Article  PubMed  Google Scholar 

  15. Wan P, Li Q, Zhang J, Xia Q (2015) Right lobe split liver transplantation versus whole liver transplantation in adult recipients: a systematic review and meta-analysis. Liver Transpl 21:928–943

    Article  PubMed  Google Scholar 

  16. Azoulay D, Castaing D, Adam R, Savier E, Delvart V, Karam V, Yan Ming B, Dannaoui M, Krissat J, Bismuth H (2001) Split-transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg 233:565–574

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Toso C, Ris F, Mentha G, Oberholzer J, Morel P, Majno P (2002) Potential impact of in situ liver splitting on the number of available grafts. Transplantation 74:222–226

    Article  PubMed  Google Scholar 

  18. Goosen K, Tenckhoff S, Probst P, Grummich K, Mihaljevic AL, Büchler MW, Diener MK (2018) Optimal literature search for systematic review in surgery. Langenbeck's Arch Surg 403:119–129

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK

    Paschalis Gavriilidis, Robert P. Sutcliffe & Keith J. Roberts

  2. Department of Hepato-Pancreato-Biliary and Liver Transplantation, Henri Mondor University Hospital, 94010, Créteil, France

    Daniel Azoulay

Authors
  1. Paschalis Gavriilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert P. Sutcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keith J. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paschalis Gavriilidis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavriilidis, P., Azoulay, D., Sutcliffe, R.P. et al. Split versus living-related adult liver transplantation: a systematic review and meta-analysis. Langenbecks Arch Surg 404, 285–292 (2019). https://doi.org/10.1007/s00423-019-01771-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-019-01771-4

Keywords

Search

Navigation