The impact of intercenter sharing on the outcomes of pediatric split liver transplantation

Background: Split liver transplantation allows for expansion of the pool of organs available for pediatric liver transplantation. The impact of sharing segments of the same liver between centers has not been studied. Study Design: Retrospective analysis of 24 pediatric split liver transplant cases in a recent cohort. We evaluated the outcomes of pediatric recipients who shared organs with adult patients in our own center (group A) compared to recipients who shared organs with adult patients in other centers. (group B). Results: One-, 3-, and 5-year graft survival for group A was 100%, 100%, and 100% vs 83%, 71%, and 57% for group B (P =.039). Postoperative complications included biliary complications (41.7% in group A vs 50% in group B, P =.682), vascular complications (8.3% in group A vs 41.7% in group B, P =.059), and postoperative bleeding (16.7% in group A vs 25% in group B, P =.615). High-grade Clavien-Dindo complications were 0% in group A vs 33.3% in group B, P =.028. Conclusions: Organ sharing between centers appears to be associated with significantly poorer graft survival. Possible explanations include greater procurement-related injury or suboptimal vessel distribution. Future larger studies focused on this area may be helpful to formulate policy considerations.