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Split liver transplantation.

ABSTRACT: BACKGROUND: Split liver transplantation offers an attractive way to increase the number of cadaveric grafts. In the past 10 years, it has enabled clinicians to minimise paediatric waiting list mortality. Two major concepts are applied in liver splitting. The more widely accepted approach provides a left lateral and a right extended liver graft to be transplanted into one child and one adult, respectively. To date the results from this technique are comparable to whole organ techniques for both the paediatric and the adult recipient. The second principle of splitting the liver provides two 'full' hemi-grafts-the left side for a small adult or big child and the right for a medium-sized adult patient. Full right/full left splitting is an important means of expanding the adult liver graft pool; however, it is a complex variant of liver transplantation that requires a high level of technical skill and a comprehensive knowledge of possible anatomic variations. Splitting for two adults should be performed in centres with a significant annual volume of liver transplantations, experience with left lateral splitting and an active program of hepatobiliary surgery. This brief review discusses anatomical and technical aspects and summarises the experience of both approaches to split liver transplantation to date.

SUBMITTER: Broering DC

PROVIDER: S-EPMC2020666 | biostudies-other | 2004

REPOSITORIES: biostudies-other

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Ex Situ Dual Hypothermic Oxygenated Machine Perfusion for Human Split Liver Transplantation.

Project description:Liver splitting allows the opportunity to share a deceased graft between 2 recipients but remains underutilized. We hypothesized that liver splitting during continuous dual hypothermic oxygenated machine perfusion (DHOPE) is feasible, with shortened total cold ischemia times and improved logistics. Here, we describe a left lateral segment (LLS) and extended right lobe (ERL) liver split procedure during continuous DHOPE preservation with subsequent transplantation at 2 different centers.MethodsAfter transport using static cold storage, a 51-year-old brain death donor liver underwent end-ischemic DHOPE. During DHOPE, the donor liver was maintained <10 °C and oxygenated with a Po2 of >106 kPa. An ex situ ERL/LLS split was performed with continuing DHOPE throughout the procedure to avoid additional ischemia time.ResultsTotal cold ischemia times for the LLS and ERL were 205 minutes and 468 minutes, respectively. Both partial grafts were successfully transplanted at 2 different transplant centers. Peak aspartate aminotransferase and alanine aminotransferase were 172 IU/L and 107 IU/L for the LLS graft, and 839 IU/L and 502 IU/L for the ERL graft, respectively. The recipient of the LLS experienced an episode of acute cellular rejection. The ERL transplantation was complicated by severe acute pancreatitis with jejunum perforation requiring percutaneous drainage and acute cellular rejection. No device-related adverse events were observed.ConclusionsLiver splitting during continuous DHOPE preservation is feasible, has the potential to substantially shorten cold ischemia time and may optimize transplant logistics. Therefore liver splitting with DHOPE can potentially improve utilization of split liver transplantation.

| S-EPMC7862033 | biostudies-literature

Outcomes following liver transplantation in young infants: Data from the SPLIT registry.

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| S-EPMC7867666 | biostudies-literature

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| S-EPMC4876853 | biostudies-literature

Adult split liver transplantation: A PRISMA-compliant Chinese single-center retrospective case-control study.

Project description:AbstractAlthough pediatric split liver transplantation (SLT) has been proven safe and the waitlist mortality rate has been successfully reduced, the safety of adult SLT has not been confirmed.Using 1:2 matching, 47 recipients who underwent adult SLT were matched to 94 of 743 recipients who underwent adult whole graft liver transplantation (WGLT). Eventually, 141 recipients were included in the case-control study. Subgroup analysis of 43 recipients in the SLT group was performed based on the presence of the middle hepatic vein (MHV) in the grafts.No significant differences in 5-year survival (80.8% vs 81.6%, P = .465) were observed between the adult SLT and WGLT groups. However, compared to recipients in the WGLT group, those in the SLT group had more Clavien-Dindo grade III-V complications, longer hospitalization duration, and higher mortality within 45 days. Furthermore, on multivariate analysis, 45-day postoperative mortality in recipients in the SLT group was mainly affected by hyperbilirubinemia within postoperative day (POD) 7-14, surgery time, and intraoperative blood loss. Subgroup analysis showed no significant differences in hyperbilirubinemia within POD 7-14, complications, and survival rate between SLTMHV(+) and SLTMHV [-].Adult SLT is safe and effective based on long-term survival rates; however, a reduction in the incidence of short-term complications is required. Non-obstructive hyperbilirubinemia within POD 7 to 14 is an independent predictor of short-term mortality after SLT.

| S-EPMC7748205 | biostudies-literature

Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement.

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| S-EPMC6773658 | biostudies-literature

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| S-EPMC8112257 | biostudies-literature

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Project description: Not available

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