American Journal of Transplantation
Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States
Split liver transplantation (SLT) is one strategy for maximizing the number of deceased donor liver transplants. Recent reports suggest that utilization of SLT in the US remains low. We examined deceased donor offers that were ultimately split between 2010‐2014. SLTs were categorized as “primary” and “secondary” transplants. We analyzed allocation patterns and used logistic regression to evaluate factors associated with secondary split discard. 418 livers were split: 54% from adult, 46% from pediatric donors. Of the 227 adult donor livers split, 61% met UNOS “optimal” split criteria. A total of 770 recipients (418 primary and 352 secondary) were transplanted, indicating 16% discard. 92% of the 418 primary recipients were children, and 47% were accepted on the first offer. 87% of the 352 secondary recipients were adults, and 7% were accepted on the first offer. Of the 352 pairs, 99% were transplanted in the same region, 36% at the same center. In logistic regression, shorter donor height was associated with secondary discard (OR 0.97 per cm, 95%CI 0.94‐1.00, p=0.02. SLT volume by center was not predictive of secondary discard. Current policy proposals that incentivize SLT in the US could increase the number of transplants to children and adults.
Source: American Journal of Transplantation