Split liver transplants could save children on wait list finds study

A review analysed 5,300 cases of liver transplants on children across the country. The team of researchers from the Johns Hopkins Medicine looked at the patients who were more likely to survive after a split liver transplant. A split liver transplant is a type of transplant where the recipient receives only a part of the donor’s liver.

The results showed that there were no long term health risks among the recipients of such split livers. The team believes that this could allow for more availability of donor livers as a single donor liver can be used for more than one recipient. The results of the review were published in the latest issue of the journal Liver Transplantation.

Lead author of the study, Douglas Mogul, medical director of the Pediatric Liver Transplant Program at Johns Hopkins Children Center and assistant professor of pediatric gastroenterology, hepatology and nutrition at the Johns Hopkins University School of Medicine said that the upside of this research is the reduction in the number of children waiting for a donor liver. He called dying of such children on the waitlist for a donor liver as the “worst possible outcome”. He added that for the past three decades there have been split liver transplants and in this around 35 to 40 percent of the liver could be used. Children with a smaller body weight can greatly benefit. He explained that a single donor liver can thus be split and transplanted to two children.

Mogul and his colleague Dorry Segev, professor of surgery at the Johns Hopkins University School of Medicine along with the whole team of researchers used the Scientific Registry of Transplant Recipients to look at the medical records of 5,345 children who had received either a split liver or a whole liver transplant in the US between 2002 March to 2015 December.

Mogul said that outcome of these transplants depends on several factors including age, general health, body weight etc. He added, “. But understanding which of these variables could impact the outcomes from transplanting a split liver versus a whole liver could help guide the increased use of split livers and identify which patients will do best after split or whole liver transplants, thereby being more strategic about matching donor organs with recipients.”

The team looked at the variables that could influence the outcome of the patients and tried to assess the transplant success of both whole and split liver transplants. They found that of the 5,345 transplants in the children, 31 percent (1,694 patients) received a split liver transplant while 68 percent (3,651 patients) received a whole liver transplant. Those who had a split liver transplant received their livers from another pediatric donor in 59 percent cases while those with whole livers received their livers from another child donor in 83 percent cases. Those with split liver transplants were less likely to have received their livers from a donor who had a lack of oxygen before death and were more likely to have died of head injuries.

Results superficially showed that those with a split liver transplant did not do as well as those with a whole liver transplant. However after all the other factors were taken into consideration, the outcomes of both types of transplants were similar. Mogul explained that those patients or the sickest of the children were anticipated to fail with their transplants more commonly. But this study showed that their outcome was not further negatively affected by the split liver transplant.

Results revealed that those recipients who weighed less than 10 kg were more likely to experience transplant failure in all the cases. Those who weighed between 10 and 35 kg however were 1.46 times more likely to experience transplant failure with split livers compared to whole livers. This means that patients of this weight group should preferably receive whole liver transplants, write the authors of the study. They noted that 22 children died while waiting on the list but could have benefited from a split liver transplant.

Mogul adds, “We hope these findings can help guide surgical decision-making and support policy changes that promote the increased use of SLT for selected children.” His colleague Segev adds, “The better understanding of SLT learned from this study and our most recent research is a critical step toward the goal of significantly increasing access to transplantation…If they wanted to, UNOS--the United Network for Organ Sharing, the entity responsible for U.S. organ allocation policies--could institute policies within one to two years that would have huge impacts on children waiting for liver transplants.”

The study was funded by the Agency for Healthcare Research and Quality and the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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