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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

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

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| S-EPMC6773658 | biostudies-literature

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

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| S-EPMC7748205 | biostudies-literature

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| S-EPMC8112257 | biostudies-literature

Full-left-full-right split liver transplantation for adult recipients: a systematic review and meta-analysis.

Project description:Full-left-full-right split liver transplantation (FSLT) for adult recipients, may increase the availability of liver grafts, reduce waitlist time, and benefit recipients with below-average body weight. However, FSLT may lead to impaired graft and patient survival. This study aims to assess outcomes after FSLT. Five databases were searched to identify studies concerning FSLT. Incidences of complications, graft- and patient survival were assessed. Discrete data were pooled with random-effect models. Graft and patient survival after FSLT were compared with whole liver transplantation (WLT) according to the inverse variance method. Vascular complications were reported in 25/273 patients after FSLT (Pooled proportion: 6.9%, 95%CI: 3.1-10.7%, I2 : 36%). Biliary complications were reported in 84/308 patients after FSLT (Pooled proportion: 25.6%, 95%CI: 19-32%, I2 : 44%). Pooled proportions of graft and patient survival after 3 years follow-up were 72.8% (95%CI: 67.2-78.5, n = 231) and 77.3% (95%CI: 66.7-85.8, n = 331), respectively. Compared with WLT, FSLT was associated with increased graft loss (pooled HR: 2.12, 95%CI: 1.24-3.61, P = 0.006, n = 189) and patient mortality (pooled HR: 1.81, 95%CI: 1.17-2.81, P = 0.008, n = 289). FSLT was associated with high incidences of vascular and biliary complications. Nevertheless, long-term patient and graft survival appear acceptable and justify transplant benefit in selected patients.

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Liver Transplantation

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| S-EPMC7122092 | biostudies-literature

Association between hospital liver transplantation volume and mortality after liver re-transplantation.

Project description:BackgroundThe relationship between institutional liver transplantation (LT) case volume and clinical outcomes after liver re-transplantation is yet to be determined.MethodsPatients who underwent liver re-transplantation between 2007 and 2016 were selected from the Korean National Healthcare Insurance Service database. Liver transplant centers were categorized to either high-volume centers (≥ 64 LTs/year) or low-volume centers (< 64 LTs/year) according to the annual LT case volume. In-hospital and long-term mortality after liver re-transplantation were compared.ResultsA total of 258 liver re-transplantations were performed during the study period: 175 liver re-transplantations were performed in 3 high-volume centers and 83 were performed in 21 low-volume centers. In-hospital mortality after liver re-transplantation in high and low-volume centers were 25% and 36% (P = 0.069), respectively. Adjusted in-hospital mortality was not different between low and high-volume centers. Adjusted 1-year mortality was significantly higher in low-volume centers (OR 2.14, 95% CI 1.05-4.37, P = 0.037) compared to high-volume centers. Long-term survival for up to 9 years was also superior in high-volume centers (P = 0.005). Other risk factors of in-hospital mortality and 1-year mortality included female sex and higher Elixhauser comorbidity index.ConclusionCenters with higher case volume (≥ 64 LTs/year) showed lower in-hospital and overall mortality after liver re-transplantation compared to low-volume centers.

| S-EPMC8341477 | biostudies-literature

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