Meta-analysis of Short-term Clinical and Survival Outcomes of Full-left-full-right Split Liver Transplantation for 2 Recipients

Abstract

This study aimed to evaluate outcomes of full-left-full-right split liver transplantation (FLFR-SLT) for 2 recipients. Comparative outcomes of full-right versus full-left grafts, and FLFR-SLT versus whole liver transplantation (WLT) were evaluated. A systematic search of electronic data sources and bibliographic reference lists were conducted. All studies reporting comparative outcomes of FLFR-SLT were included and their risk of bias were assessed. Estimate of effect size for hepatic artery thrombosis (HAT), venous complications, biliary complications, primary nonfunction (PNF), small-for-size syndrome, retransplantation, and graft and patient survival were determined using random-effects model. Sixteen observational studies reporting a total of 3139 patients were included. Full-right (n = 220) and full-left (n = 230) SLT were associated with no significant difference in HAT (OR 1.09; P = 0.88), venous complications (RD –0.02; P = 0.51), biliary complications (OR 1.04; P = 0.89), small-for-size (RD –0.02; P = 0.34), PNF (OR 0.51; P = 0.26), or retransplantation (OR 0.46; P = 0.19). Moreover, there was no significant difference in 1-y (OR 0.99; P = 0.99), 5-y (OR 0.90; P = 0.73) patient-survival, or 1-y (OR 1.13; P = 0.72), and 5-y (OR 1.10; P = 0.75) graft-survival between 2 groups. Although FLFR-SLT was associated with similar risk of HAT (OR 2.68; P = 0.15) when compared with WLT (n = 2689), it significantly increased risk of venous complications (OR 32.8; P = 0.002) and biliary complications (OR 3.41; P = 0.0001) and decreased 1-y (OR 0.33, P < 0.00001) and 5-y (OR 0.52, P = 0.01) graft-survival and 1-y patient survival (OR 0.46, P = 0.0003). The meta-analysis of best available evidence (level 2a) indicates that full-right and full-left split liver transplantation have comparable short-term clinical, graft-and patient-survival outcomes. However, when compared with WLT, FLFR-SLT significantly increases posttransplantation complications and decreases graft and patient survival.