Liver Update: Past Time to Split (2022) & Graft Fibrosis -Will the Liver Last?

In previous posts (see below), the benefits of split-liver transplantation has been discussed, chiefly reducing pediatric waitlist mortality. A recent study (MG Bowring et al. Liver Transplantation 2022; 28: 969-982. Survival Benefit of Split-Liver Transplantation for Pediatric and Adult Candidates) shows split livers improve survival for pediatric and adult recipients.

Methods:  The researchers sought to determine the survival benefit associated with accepting a splittable graft offer for SLT versus declining and waiting for a subsequent offer using 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) data on 928 pediatric and 1814 adult liver transplantation candidates who were ever offered a splittable graft

Key findings:

  • Among adult candidates, split liver offer acceptance was associated with a 43% reduction in mortality (aHR, 0.390.570.83 [P = 0.005]; 92.2% versus 84.4% 1-year survival after decision)
  • Among pediatric candidates ≤7 kg, split liver offer acceptance versus decline was associated with a 63% reduction in mortality (adjusted hazard ratio [aHR], 0.170.370.80 [P = 0.01]; 93.1% versus 84.0% 1-year survival after decision). Among pediatric candidates >7 kg, there was no significant difference associated with acceptance of a split liver offer (aHR, 0.631.071.82 [P = 0.81]; 91.7% versus 94.4% 1-year survival after decision)

My take: These findings should spur more efforts at incentivizing the use of split livers.

Unrelated article: ER Perito et al. Liver Transplantation 2022; 28: 1051-1062. Graft Fibrosis Over 10 to 15 Years in Pediatric Liver Transplant Recipients: Multicenter Study of Paired, Longitudinal Surveillance Biopsies

Key findings (n=78):

  • The first biopsy, at a median 8.2 years (interquartile range, 5.9-11.6 years) after transplantation, showed moderate (LAFSc 4-6) in 55%, and severe (LAFSc 7 or higher) in 3% of patients.
  • The second biopsy, at a median 4.7 years (IQR, 4.3-5.1 years) later, showed moderate (LAFSc 4-6) in 62%, and severe (LAFSc 7 or higher) in 5% of patients.. Thus, there was fibrosis progression (LAFSc increased by ≥3) in 10 (13%) and regression (LAFSc decreased by ≥3) in 4 (5%) patients.

Related blog posts:

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