Outcomes of left split graft transplantation in Europe: report from the European Liver Transplant Registry

Transpl Int. 2018 Jul;31(7):739-750. doi: 10.1111/tri.13147. Epub 2018 Mar 30.


Split liver transplantation (SLT) has been widely adopted across Europe, resulting in remarkable reduction in the paediatric waiting-list mortality. Left split graft (LSG) is commonly used for paediatric recipients; however, deceased donor criteria selection are not universal. The aim of this study was to analyse the LSG outcome from the European Liver Transplant Registry and to identify risk factors for graft failure. Data from 1500 children transplanted in 2006-2014 with LSG from deceased donors were retrospectively analysed. Overall, graft losses were 343(22.9%) after 5 years from transplantation, 240(70.0%) occurred within the first 3 months. Estimated patient survival was 89.1% at 3 months and 82.9% at 5 years from SLT. Re-transplantation rate was 11.5%. At multivariable analysis, significant risk factors for graft failure at 3 months included the following: urgent SLT (HR = 1.73, P = 0.0012), recipient body weight ≤6 kg (HR = 1.91, P = 0.0029), donor age >50 years (HR = 1.87, P = 0.0039), and cold ischaemic time (CIT) [HR = 1.07 per hour, P = 0.0227]. LSG has good outcomes and SLT is excellent option for paediatric recipients in the current organ shortage era. We identified practical guidelines for LSG donor and recipient selection criteria: donor age may be safely extended up to 50 years in the absence of additional risk factors; thus, children <6 kg and urgent transplantation need CIT <6 h and appropriate graft/recipient size-matching to achieve good outcomes.

Keywords: European Liver Transplant Registry; donor and recipient risk factors; left split graft; outcomes; paediatric transplantation; split liver transplantation.

MeSH terms

  • Child, Preschool
  • Europe / epidemiology
  • Female
  • Graft Survival
  • Humans
  • Infant
  • Liver Transplantation / methods
  • Liver Transplantation / mortality*
  • Male
  • Registries*
  • Retrospective Studies
  • Risk Factors