Right Ex Situ Split Grafts for Adult Liver Transplantation: A Multicenter Benchmarking Analysis.

Abstract

To analyze outcomes after adult right ex situ split graft liver transplantations and compare with available outcome benchmarks from whole liver transplantation (WLT). Ex-situ split liver transplantation (SLT) may be a valuable strategy to tackle the increasing graft shortage. Recently established outcome benchmarks in WLT offer a novel reference to perform a comprehensive analysis of results after ex situ right split liver transplantation. This retrospective multicenter cohort study analyzes all consecutive adult SLT performed using right ex situ split grafts from January 1, 2014, to June 1, 2022. Study endpoints included 1-year graft and recipient survival, overall morbidity expressed by the comprehensive complication index (CCI), and specific post-LT complications. Results were compared with the published benchmark outcomes in low-risk adult WLT scenarii. In 224 adult right ex-situ SLT, the 1-year recipient and graft survival rates were 96% and 91.5%, within the WLT benchmarks. The 1-year overall morbidity was also within the WLT benchmark (41.8 CCI points vs <42.1). Detailed analysis revealed cut surface bile leaks (17%, 65.8% grade IIIa) as a specific complication without a negative impact on graft survival. There was a higher rate of early hepatic artery thrombosis after SLT, above the WLT benchmark (4.9% vs ≤4.1%), with a significant impact on early graft but not patient survival. In this multicentric study of right ex situ split graft LT, we report 1-year overall morbidity and mortality rates within the published benchmarks for low-risk WLT. Cut surface bile leaks and early hepatic artery thrombosis are specific complications of SLT and should be acknowledged when expanding the use of ex situ SLT.