Introduction Concern exist as to the outcome of patients with liver cirrhosis secondary to hepatitis C virus (HCV) infection who receive split liver transplantation (SLT).
Aim To determine the graft and patient outcomes following SLT and to identify factors that influence outcome.
Method Retrospective study of all adults transplanted for HCV cirrhosis at our centre from 2000 to 2008.
Results Of 1284 patients, 242 were transplanted for HCV. 19 were excluded because of re-transplantation and 11 excluded as they received living donor grafts. Of the remaining 212, 21 received cadaveric SLT and 191 received whole liver grafts (WLT). Median age was 52 years (IQR 47–59). Men comprised 80%. No significant difference found in age, gender, serum Na and HCC between SLT and WLT groups (p=NS). However, there was significant difference in median transplant MELD between SLT, 11 (IQR 5.8) and WLT 14 (IQR 6.7, p=0.047). Virological and/or histological recurrence in graft (any fibrosis) was confirmed in 18/21 (86%). There was no significant difference in post-LT RNA between SLT & WLT (p=0.117) within 6 months of transplant. Median ICU stay was 3 days (IQR 2–5) and median hospital stay was 20 days (IQR 14–33). There was no significant difference in ICU or hospital stay between groups (p=NS). Kaplan–Meier analysis showed no significant difference in patient (Log rank=1.74, p=0.187) or graft (Log rank=2.47, p=0.12) survival in SLT vs WLT with median follow-up of 3.28 years (IQR 1.17–6.05). Univariate analysis revealed that recipient gender, donor risk index >1.7, donor age, height, BMI>25, cold ischaemia time (CIT) >10 h and graft steatosis were significant factors in relation to outcome. On multivariate analysis, only recipient gender (HR 0.142, p=0.001), donor age (HR 0.944, p=0.008), donor BMI >25 (HR 0.276, p=0.015) and CIT >10 hours (HR 0.218, p=0.004) remained significant. There was no significant difference in patient survival for SLT in HCV+/HCV- patients. However, graft survival was significantly improved in HCV+ patients (Log rank 4.12, p=0.042). Recipient gender (male 82% of HCV+, p=0.0001), HCC (54% of HCV+, p=0.0001) and mean MELD (HCV+ 11, HCV− 14, p=0.006) were significantly different. Donor variables were not significantly different.
Conclusion In our cohort, SLT for HCV+ patients provides a good alternative to WLT with comparable outcomes. Recipient selection accounted for improved graft outcomes for HCV+ group.
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