Transplant Surgery

FLFR-SLT vs whole liver: similar vs split, worse vs whole for complications and graft survival

Meta-analysis of 16 observational studies (n=3139) found full-right and full-left split grafts had similar HAT, biliary complications, and 1- and 5-year survival to each other. Compared with whole liver transplantation, FLFR-SLT significantly increased venous complications (OR 32.8) and biliary complications (OR 3.41). FLFR-SLT was associated with lower 1-year patient survival (OR 0.46) and reduced 1- and 5-year graft survival (OR 0.33 and 0.52). Conclusion: FLFR-SLT is reasonable compared with other split techniques but carries higher complication rates and worse survival than whole grafts. 1

SLKT survival benefit concentrated in severe renal dysfunction; effect attenuated after 2017 policy

Registry analysis of 63,407 adult liver transplants (57,780 LTA; 5,627 SLKT) stratified by pretransplant eGFR. No survival benefit for SLKT when pretransplant eGFR ≥30 mL/min/1.73 m2; LTA had comparable or better outcomes in this group. For eGFR 15–29, SLKT reduced 1-, 3-, and 5-year mortality by 25%, 15%, and 13%, respectively; for eGFR <15, reductions were 32%, 24%, 22%, and 17% at 1, 3, 5, and 10 years. After the 2017 OPTN policy and Safety Net, SLKT frequency declined and the pre-policy survival advantage was no longer evident. 2

Robotic recipient liver transplantation: early series show feasibility and low short-term mortality

Systematic review and meta-analysis identified 93 robotic liver transplants across 10 studies, mostly living-donor right lobe grafts in selected recipients. Pooled complications included bleeding 7.0%, AKI 9.2%, biliary complications 8.5%, and hepatic artery thrombosis 4.3%; conversion to open surgery was 2.9%. Major morbidity occurred in 17.2% and pooled 6-month survival was 98.0% in these early, highly selected series. Implication: technically feasible with promising short-term outcomes, but evidence is limited to specialized centers and small series. 3