To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P =.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P =.045]). The pediatric (4.5% vs 2.5% [P =.398]) and adult (9.7% to 5.2% [P <.001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P =.035) and recipient weight >20 kg (HR = 5.113, P =.048) in LLS, and ischemic time >8 hours (HR = 2.475, P =.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.

A national mandatory-split liver policy: A report from the Italian experience / Angelico, R.; Trapani, S.; Spada, M.; Colledan, M.; de Ville de Goyet, J.; Salizzoni, M.; De Carlis, L.; Andorno, E.; Gruttadauria, S.; Ettorre, G. M.; Cescon, M.; Rossi, G.; Risaliti, A.; Tisone, G.; Tedeschi, U.; Vivarelli, M.; Agnes, S.; De Simone, P.; Lupo, L. G.; Di Benedetto, F.; Santaniello, W.; Zamboni, F.; Mazzaferro, V.; Rossi, M.; Puoti, F.; Camagni, S.; Grimaldi, C.; Gringeri, E.; Rizzato, L.; Nanni Costa, A.; Cillo, U.. - In: AMERICAN JOURNAL OF TRANSPLANTATION. - ISSN 1600-6135. - 19:7(2019), pp. 2029-2043. [10.1111/ajt.15300]

A national mandatory-split liver policy: A report from the Italian experience

Vivarelli M.;Di Benedetto F.;
2019

Abstract

To implement split liver transplantation (SLT) a mandatory-split policy has been adopted in Italy since August 2015: donors aged 18-50 years at standard risk are offered for SLT, resulting in a left-lateral segment (LLS) graft for children and an extended-right graft (ERG) for adults. We aim to analyze the impact of the new mandatory-split policy on liver transplantation (LT)-waiting list and SLT outcomes, compared to old allocation policy. Between August 2015 and December 2016 out of 413 potentially “splittable” donors, 252 (61%) were proposed for SLT, of whom 53 (21%) donors were accepted for SLT whereas 101 (40.1%) were excluded because of donor characteristics and 98 (38.9%) for absence of suitable pediatric recipients. The SLT rate augmented from 6% to 8.4%. Children undergoing SLT increased from 49.3% to 65.8% (P =.009) and the pediatric LT-waiting list time dropped (229 [10-2121] vs 80 [12-2503] days [P =.045]). The pediatric (4.5% vs 2.5% [P =.398]) and adult (9.7% to 5.2% [P <.001]) LT-waiting list mortality reduced; SLT outcomes remained stable. Retransplantation (HR = 2.641, P =.035) and recipient weight >20 kg (HR = 5.113, P =.048) in LLS, and ischemic time >8 hours (HR = 2.475, P =.048) in ERG were identified as predictors of graft failure. A national mandatory-split policy maximizes the SLT donor resources, whose selection criteria can be safely expanded, providing favorable impact on the pediatric LT-waiting list and priority for adult sick LT candidates.
2019
19
7
2029
2043
A national mandatory-split liver policy: A report from the Italian experience / Angelico, R.; Trapani, S.; Spada, M.; Colledan, M.; de Ville de Goyet, J.; Salizzoni, M.; De Carlis, L.; Andorno, E.; Gruttadauria, S.; Ettorre, G. M.; Cescon, M.; Rossi, G.; Risaliti, A.; Tisone, G.; Tedeschi, U.; Vivarelli, M.; Agnes, S.; De Simone, P.; Lupo, L. G.; Di Benedetto, F.; Santaniello, W.; Zamboni, F.; Mazzaferro, V.; Rossi, M.; Puoti, F.; Camagni, S.; Grimaldi, C.; Gringeri, E.; Rizzato, L.; Nanni Costa, A.; Cillo, U.. - In: AMERICAN JOURNAL OF TRANSPLANTATION. - ISSN 1600-6135. - 19:7(2019), pp. 2029-2043. [10.1111/ajt.15300]
Angelico, R.; Trapani, S.; Spada, M.; Colledan, M.; de Ville de Goyet, J.; Salizzoni, M.; De Carlis, L.; Andorno, E.; Gruttadauria, S.; Ettorre, G. M.; Cescon, M.; Rossi, G.; Risaliti, A.; Tisone, G.; Tedeschi, U.; Vivarelli, M.; Agnes, S.; De Simone, P.; Lupo, L. G.; Di Benedetto, F.; Santaniello, W.; Zamboni, F.; Mazzaferro, V.; Rossi, M.; Puoti, F.; Camagni, S.; Grimaldi, C.; Gringeri, E.; Rizzato, L.; Nanni Costa, A.; Cillo, U.
File in questo prodotto:
File Dimensione Formato  
ajt.15300.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 1.61 MB
Formato Adobe PDF
1.61 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1222798
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 53
  • ???jsp.display-item.citation.isi??? 47
social impact