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Andrassy, Joachim; Wolf, S.; Lauseker, Michael; Angele, Martin K.; van Rosmalen, M. D.; Samuel, U.; Rogiers, X.; Werner, J.; Guba, Markus (January 2018): Higher Retransplantation rate following Extended Right Split-Liver Transplantation - an analysis from the Eurotransplant Liver follow-up Registry. In: Liver Transplantation, Vol. 24, No. 1: pp. 26-34
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Split liver transplantation (SLT) has been perceived as an important strategy to increase the supply of liver grafts by creating 2 transplants from 1 allograft. The Eurotransplant allocation system (ELAS) envisages that the ERLs after splitting (usually in the pediatric center) are almost exclusively shipped to a second center. Whether the ELAS policy impacts the graft and patient survival of ERLT in comparison to WLT recipients remains unclear. Data on all LTs performed between 2007 and 2013 were retrieved from the ET Liver follow-up Registry (n=5351). Data on n=5013 (269 ERL, 4744 WL) could be included. The impact of the transplant type on patient and graft survival was evaluated using uni- and multivariate proportional hazard models adjusting for demographics of donors and recipients. Cold ischemia times (CIT) were significantly prolonged for ERLTs (p<0.001). Patient survival was not different between ERLT and WLT. In the univariate analysis ERLT had a significantly higher risk for retransplantation (p=0.02). For WLT the risk for death gradually and significantly increased with lab Meld-scores of >20. For ERLT this effect was seen already with lab MELD scores of >14. These results mandate a discussion on how to refine the splitting policy to avoid excess retransplant rates in ERL recipients and to further improve transplant outcomes of these otherwise optimal donor organs.