A group of Johns Hopkins Medicine researchers have recently identified what type of patient’s are most likely to benefit from a split liver transplant, receiving only part of the donor’s liver. Reviewing over 5,300 liver transplants performed in children, this team published their comprehensive findings in this month’s edition of Liver Transplantation.
Examining 5,345 pediatric liver recipient records, theresearchers found that 31% received a split liver transplant, while 68%received a whole liver. Those receiving split livers were less likely thanwhole liver recipients to receive the organ from another child, at 59% comparedto 83%. 38% of these pediatric recipients received their partial liver from adonor between ages 18 and 50, with only 13% of the whole liver donations beingfrom donors in this age range. In short, the pediatric split liver transplants requirechild donors at much lower rates than the whole liver transplants.
Initially, the data makes it appear that the split liver transplants reduced patient outcomes; however, after adjusting data for the donor’s age, weight and overall health, as well as surgical methods used, the researchers found there was no difference in outcomes for whole versus split liver transplants. One of the team’s most significant findings was that groups of certain characteristics that had the highest rate of transplant failure were not actually negatively impacted by having a split versus a whole liver. This finding implies that the sickest children are best candidates for split livers.
“One might anticipate that patients with the highest likelihood of graft failure would do worse if they got a split compared to a whole. But we saw the opposite: These people were not further impacted by getting a split,” said Dr. Douglas Mogul, medical director of the Pediatric Liver Transplant Program at Johns Hopkins Children Center and assistant professor at Johns Hopkins University School of Medicine.
Those who weighed under 10 kilograms had increased risks oftransplant failures regardless of whether they received split or whole livers,providing evidence that a body weight under this threshold may be an importantfactor to consider before conducting any liver transplantation. On the otherhand, patients between 10 and 35 kilograms who received split livers were 1.46times more likely to experience failure than those receiving a whole liver.This should give practitioners pause in selecting candidates for a split livertransplant, with those between 10 and 35 kilograms potentially being better fitfor a whole liver transplant.
Mogul notes that split liver transplants have been in practice for almost 30 years, and that the procedure can use a 35 to 40% section of the liver, making this procedure well suited for children with smaller body mass. “An SLT (split liver transplant) essentially could allow two transplants from a single liver,” claims Mogul. This research builds upon the previous knowledge of split liver transplants by not only showing the efficacy of the procedure, but by establishing threshold weights at which the procedure may or may not be appropriate.
Overall, Mogul claims that waiting children of lower body weights and worse overall health, whose donor livers spent more time in transit or on ice, had the similar outcomes with split liver transplants as they would have with a whole liver. The research team estimates that 22 children on the liver transplant list could have received split liver transplants, but died while waiting for a donor instead.
“We hope these findings can help guide surgical decision-making and support policy changes that promote the increased use of SLT for selected children,” Mogul concludes.