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.
Angelico, R., Trapani, S., Spada, M., Colledan, M., de Ville de Goyet, J., Salizzoni, M., et al. (2019). A national mandatory-split liver policy: A report from the Italian experience. AMERICAN JOURNAL OF TRANSPLANTATION, 19(7), 2029-2043.
|Tipologia:||Articolo su rivista|
|Citazione:||Angelico, R., Trapani, S., Spada, M., Colledan, M., de Ville de Goyet, J., Salizzoni, M., et al. (2019). A national mandatory-split liver policy: A report from the Italian experience. AMERICAN JOURNAL OF TRANSPLANTATION, 19(7), 2029-2043.|
|Settore Scientifico Disciplinare:||Settore MED/18|
|Revisione (peer review):||Esperti anonimi|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/ajt.15300|
|Stato di pubblicazione:||Pubblicato|
|Data di pubblicazione:||2019|
|Titolo:||A national mandatory-split liver policy: A report from the Italian experience|
|Autori:||Angelico, R; Trapani, S; Spada, M; Colledan, M; de Ville de Goyet, J; Salizzoni, M; De Carlis, L; Andorno, E; Gruttadauria, S; Ettorre, GM; Cescon, M; Rossi, G; Risaliti, A; Tisone, G; Tedeschi, U; Vivarelli, M; Agnes, S; De Simone, P; Lupo, LG; 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|
|Appare nelle tipologie:||01 - Articolo su rivista|