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, 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.. - In: AMERICAN JOURNAL OF TRANSPLANTATION. - ISSN 1600-6135. - ELETTRONICO. - (2019). [10.1111/ajt.15300]