Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States

• Published in: American journal of transplantation Vol. 20; no. 4; pp. 1116 - 1124
• Main Authors: Ge, Jin, Perito, Emily R., Bucuvalas, John, Gilroy, Richard, Hsu, Evelyn K., Roberts, John P., Lai, Jennifer C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.04.2020
• Subjects: Adult; Adults; Child; Children; disparities; donors and donation; ethics and public policy; Graft Survival; health services and outcomes research; Humans; liver transplant: split; Liver Transplantation; liver transplantation/hepatology; Liver transplants; Living Donors; Medical ethics; organ allocation; organ procurement and allocation; Organ Procurement and Transplantation Network (OPTN); Pediatrics; Tissue and Organ Procurement; Tissue Donors; Transplants; Transplants & implants; United States; United States; United States > US; disparities; Organ Procurement and Transplantation Network (OPTN); ethics and public policy; organ procurement and allocation; pediatrics; liver transplant: split; organ allocation; liver transplantation/hepatology; donors and donation; health services and outcomes research
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15696

Split liver transplantation (SLT) is 1 strategy for maximizing the number of deceased donor liver transplants. Recent reports suggest that utilization of SLT in the United States remains low. We examined deceased donor offers that were ultimately split between 2010 and 2014. SLTs were categorized as “primary” and “secondary” transplants. We analyzed allocation patterns and used logistic regression to evaluate factors associated with secondary split discard. Four hundred eighteen livers were split: 54% from adult, 46% from pediatric donors. Of the 227 adult donor livers split, 61% met United Network for Organ Sharing “optimal” split criteria. A total of 770 recipients (418 primary and 352 secondary) were transplanted, indicating 16% discard. Ninety‐two percent of the 418 primary recipients were children, and 47% were accepted on the first offer. Eighty‐seven percent of the 352 secondary recipients were adults, and 7% were accepted on the first offer. Of the 352 pairs, 99% were transplanted in the same region, 36% at the same center. In logistic regression, shorter donor height was associated with secondary discard (odds ratio 0.97 per cm, 95% CI 0.94‐1.00, P = .02). SLT volume by center was not predictive of secondary discard. Current policy proposals that incentivize SLT in the United States could increase the number of transplants to children and adults. In this analysis of deceased donor liver offers in the United States that were ultimately split between 2010‐2014, the authors find that split liver transplants most often benefit a smaller adult (median height of 163cm) and a child, only 61% of adult deceased donor livers split met “optimal” split criteria, and shorter donor height was associated with secondary discard.