Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1522-1531
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1522
Outcome of split liver transplantation vs living donor liver transplantation: A systematic review and meta-analysis
Ibrahim Umar Garzali, Sami Akbulut, Ali Aloun, Motaz Naffa, Fuat Aksoy
Ibrahim Umar Garzali, Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
Sami Akbulut, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Ali Aloun, Motaz Naffa, Royal Medical Services, King Hussein Medical Center, Amman 11855, Jordan
Fuat Aksoy, Department of Surgery, Uludag University Faculty of Medicine, Bursa 16059, Turkey
Author contributions: Garzali IU, Akbulut S, Aksoy F and Aloun A contributed to the conceptualization; Garzali IU and Aloun A contributed to the formal analysis; Garzali IU and Naffa M performed the methodology and wrote the original draft; Akbulut S and Garzali IU wrote the review and contributed to editing.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, FACS, FICS, MD, PhD, Professor, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: November 25, 2022
Peer-review started: November 25, 2022
First decision: February 20, 2023
Revised: February 22, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: July 27, 2023
Processing time: 238 Days and 13.6 Hours
Abstract
BACKGROUND

The outcomes of liver transplantation (LT) from different grafts have been studied individually and in combination, but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT (DD-SLT) and living donor LT (LDLT).

AIM

To compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.

METHODS

This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The following databases were searched for articles comparing outcomes of DD-SLT and LDLT: PubMed; Google Scholar; Embase; Cochrane Central Register of Controlled Trials; the Cochrane Database of Systematic Reviews; and Reference Citation Analysis (https://www.referencecitationanalysis.com/). The search terms used were: “liver transplantation;” “liver transplant;” “split liver transplant;” “living donor liver transplant;” “partial liver transplant;” “partial liver graft;” “ex vivo splitting;” and “in vivo splitting.”

RESULTS

Ten studies were included for the data synthesis and meta-analysis. There were a total of 4836 patients. The overall survival rate at 1 year, 3 years and 5 years was superior in patients that received LDLT compared to DD-SLT. At 1 year, the hazard ratios was 1.44 (95% confidence interval: 1.16-1.78; P = 0.001). The graft survival rate at 3 years and 5 years was superior in the LDLT group (3 year hazard ratio: 1.28; 95% confidence interval: 1.01-1.63; P = 0.04).

CONCLUSION

This meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT.

Keywords: Deceased donor liver transplantation; Living donor liver transplantation; Split liver transplantation; Overall survival; Graft survival; Acute rejection

Core Tip: This meta-analysis is one of the few studies in the literature to compare the deceased donor split liver transplantation (DD-SLT) and living donor liver transplantation (LDLT) patients in terms of clinical outcomes. Although this study had some limitations, this meta-analysis showed that LDLT has better graft survival and overall survival compared to DD-SLT. The allograft in LDLT also had superior outcomes compared to DD-SLT in terms of acute rejection.