Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center

Narendra R Battula; Marco Plato; Ravindar Anbarasan; M Thamara P R Perera; Evelyn Ong; Garrett R Roll; Ben-Hur Ferraz Neto; Hynek Mergental; John Isaac; Paolo Muiesan; Khalid Sharif; Darius F Mirza

doi:10.1097/SLA.0000000000001816

Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center

Narendra R Battula, Marco Plato, Ravindar Anbarasan, M Thamara P R Perera, Evelyn Ong, Garrett R Roll, Ben-Hur Ferraz Neto, Hynek Mergental, John Isaac, Paolo Muiesan, Khalid Sharif, Darius F Mirza

Immunology and Immunotherapy

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Abstract

OBJECTIVE: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an "intention to split policy."

BACKGROUND: SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.

METHODS: Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.

RESULTS: Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of "intention to split policy" resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.

CONCLUSIONS: SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.

Original language	English
Journal	Annals of surgery
Early online date	1 Jun 2016
DOIs	https://doi.org/10.1097/SLA.0000000000001816
Publication status	E-pub ahead of print - 1 Jun 2016

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This is the author accepted peer reviewed manuscript. The final published version can be found at http://dx.doi.org/10.1097/SLA.0000000000001816 Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
Accepted author manuscript, 874 KBLicence: None: All rights reserved

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Battula, N. R., Plato, M., Anbarasan, R., Perera, M. T. P. R., Ong, E., Roll, G. R., Neto, B.-H. F., Mergental, H., Isaac, J., Muiesan, P., Sharif, K., & Mirza, D. F. (2016). Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center. Annals of surgery. Advance online publication. https://doi.org/10.1097/SLA.0000000000001816

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title = "Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center",

abstract = "OBJECTIVE: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an {"}intention to split policy.{"}BACKGROUND: SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.METHODS: Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.RESULTS: Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of {"}intention to split policy{"} resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.CONCLUSIONS: SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.",

author = "Battula, {Narendra R} and Marco Plato and Ravindar Anbarasan and Perera, {M Thamara P R} and Evelyn Ong and Roll, {Garrett R} and Neto, {Ben-Hur Ferraz} and Hynek Mergental and John Isaac and Paolo Muiesan and Khalid Sharif and Mirza, {Darius F}",

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day = "1",

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language = "English",

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T1 - Intention to split policy

T2 - a successful strategy in a combined pediatric and adult liver transplant center

AU - Battula, Narendra R

AU - Plato, Marco

AU - Anbarasan, Ravindar

AU - Perera, M Thamara P R

AU - Ong, Evelyn

AU - Roll, Garrett R

AU - Neto, Ben-Hur Ferraz

AU - Mergental, Hynek

AU - Isaac, John

AU - Muiesan, Paolo

AU - Sharif, Khalid

AU - Mirza, Darius F

PY - 2016/6/1

Y1 - 2016/6/1

N2 - OBJECTIVE: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an "intention to split policy."BACKGROUND: SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.METHODS: Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.RESULTS: Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of "intention to split policy" resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.CONCLUSIONS: SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.

AB - OBJECTIVE: The primary aim of this study is to evaluate the role of split liver transplantation (SLT) in a combined pediatric and adult liver transplant center. The secondary aim is to reflect on our clinical practice and discuss strategies to build a successful split program using an "intention to split policy."BACKGROUND: SLT is an established procedure to expand the organ pool and reduce wait list mortality; however, technical and logistic issues are limiting factors.METHODS: Prospectively collected data and outcomes of SLT procedures performed between November 1992 and March 2014 were analyzed retrospectively. To assess the effect of standardization and learning curve, the experience was divided into 2 time periods.RESULTS: Out of 3449 liver transplant procedures performed, 516(15%) were SLT. The recipients included 266 children (290 grafts; 56%) and 212 adults (226 grafts; 44%). The median donor age was 25(7-63 years) and the median weight was 70(22-111 kg). The cold and warm ischemic times improved significantly during the second period (SP) (2001-2014). With experience, there was a significant reduction in the biliary complications for both grafts. The introduction of "intention to split policy" resulted in a significantly increased usage of SLT. There was no mortality on the pediatric wait list for last 4 years. Over the last decade 65% of our pediatric transplants were SLT. The overall 1-, 5-, 10-year patient and graft survival of left graft recipients was 91%, 90%, and 89% and 90%, 87%, and 86%. For right grafts it was 87%, 82%, and 81% and 82%, 81%, and 79%, respectively.CONCLUSIONS: SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.

U2 - 10.1097/SLA.0000000000001816

DO - 10.1097/SLA.0000000000001816

M3 - Article

C2 - 27257738

SN - 0003-4932

JO - Annals of surgery

JF - Annals of surgery

ER -

Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center

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