Outcome of split liver transplantation vs living donor liver transplantation: A systematic review and meta-analysis

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.