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Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?

Publication ,  Journal Article
Sasaki, K; Firl, DJ; McVey, JC; Schold, JD; Iuppa, G; Diago Uso, T; Fujiki, M; Aucejo, FN; Quintini, C; Eghetsad, B; Miller, CM; Hashimoto, K
Published in: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
May 2019

A recent study using US national registry data reported, using Cox proportional hazards (PH) models, that split-liver transplantation (SLT) has improved over time and is no more hazardous than whole-liver transplantation (WLT). However, the study methods violated the PH assumption, which is the fundamental assumption of Cox modeling. As a result, the reported hazard ratios (HRs) are biased and unreliable. This study aimed to investigate whether the risk of graft survival (GS) in SLT has really improved over time, ensuring attention to the PH assumption. This study included 80,998 adult deceased donor liver transplantation (LT) (1998-2015) from the Scientific Registry Transplant Recipient. The study period was divided into 3 time periods: era 1 (January 1998 to February 2002), era 2 (March 2002 to December 2008), and era 3 (January 2009 to December 2015). The PH assumption was tested using Schoenfeld's test, and where the HR of SLT violated the assumption, changes in risk for SLT over time from transplant were assessed. SLT was performed in 1098 (1.4%) patients, whereas WLT was used in 79,900 patients. In the Cox PH analysis, the P values of Schoenfeld's global tests were <0.05 in all eras, which is consistent with deviation from proportionality. Assessing HRs of SLT with a time-varying effect, multiple Cox models were conducted for post-LT intervals. The HR curves plotted according to time from transplant were higher in the early period and then decreased at approximately 1 year and continued to decrease in all eras. For 1-year GS, the HRs of SLT were 1.92 in era 1, 1.52 in era 2, and 1.47 in era 3 (all P < 0.05). In conclusion, the risk of SLT has a time-varying effect and is highest in the early post-LT period. The risk of SLT is underestimated if it is evaluated by overall GS. SLT was still hazardous if the PH assumption was considered, although it became safer over time.

Duke Scholars

Published In

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

DOI

EISSN

1527-6473

ISSN

1527-6465

Publication Date

May 2019

Volume

25

Issue

5

Start / End Page

741 / 751

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Transplant Recipients
  • Tissue Donors
  • Time Factors
  • Surgery
  • Registries
  • Middle Aged
  • Male
 

Citation

APA
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ICMJE
MLA
NLM
Sasaki, K., Firl, D. J., McVey, J. C., Schold, J. D., Iuppa, G., Diago Uso, T., … Hashimoto, K. (2019). Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast? Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 25(5), 741–751. https://doi.org/10.1002/lt.25409
Sasaki, Kazunari, Daniel J. Firl, John C. McVey, Jesse D. Schold, Giuseppe Iuppa, Teresa Diago Uso, Masato Fujiki, et al. “Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 25, no. 5 (May 2019): 741–51. https://doi.org/10.1002/lt.25409.
Sasaki K, Firl DJ, McVey JC, Schold JD, Iuppa G, Diago Uso T, et al. Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast? Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2019 May;25(5):741–51.
Sasaki, Kazunari, et al. “Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast?Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 25, no. 5, May 2019, pp. 741–51. Epmc, doi:10.1002/lt.25409.
Sasaki K, Firl DJ, McVey JC, Schold JD, Iuppa G, Diago Uso T, Fujiki M, Aucejo FN, Quintini C, Eghetsad B, Miller CM, Hashimoto K. Elevated Risk of Split-Liver grafts in adult liver Transplantation: Statistical Artifact or Nature of the Beast? Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2019 May;25(5):741–751.
Journal cover image

Published In

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

DOI

EISSN

1527-6473

ISSN

1527-6465

Publication Date

May 2019

Volume

25

Issue

5

Start / End Page

741 / 751

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Transplant Recipients
  • Tissue Donors
  • Time Factors
  • Surgery
  • Registries
  • Middle Aged
  • Male