Comparison of Survival Outcomes After Deceased Donor Split Versus Whole Liver Transplant for Hepatocellular Carcinoma

Objectives: To mitigate waiting time for liver transplant for hepatocellular carcinoma, partial or split liver transplant has been utilized. There was concern that regeneration of these grafts would negatively affect oncologic outcomes. Materials and Methods: We compared posttransplant graft survival between hepatocellular carcinoma whole liver transplant and partial/split liver transplant using Scientific Registry of Transplant Recipients data (2002-2017). The 330 partial/split liver transplant recipients were compared with a logistic regression-based propensity score 1:1 matched whole liver transplant cohort (n = 330) and a random unmatched whole liver transplant cohort (n = 4143). Kaplan-Meier and multivariable Cox regression models evaluated the effects of partial/split and whole liver transplant on survival. Results: Unadjusted analysis demonstrated no difference in graft survival between the partial/split and whole liver transplant cohorts (overall log-rank P =.78). After adjustments for recipient age, last laboratory Model for End-stage Liver Disease score, hepatitis B viral infection co-diagnosis, liver donor risk index, donor history of diabetes, and donor body mass index category were made (all P <.05), multivariable analysis demonstrated no statistically significant difference in the risk of graft failure in the partial/split liver transplant cohort compared with either the matched or random whole liver transplant cohort (both P =.23). Conclusions: Partial/split liver transplant was not an independent risk factor for graft failure. Additional studies are needed to further elucidate differences in these populations to determine the "right" candidate for partial/split liver transplant.