Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Abstract

Split-liver transplantation (LT) allows transplantation of two recipients from one deceased donor, thereby increasing pool of grafts. However, split LT may be hampered by technical problems, and split grafts are still considered suboptimal organs in some centres. We analysed the outcomes in split- and whole-liver recipients in a combined adult-to-paediatric transplantation programme. Records of paediatric and adult patients having undergone LT from 1999 to 2013 were analysed retrospectively. All splits were performed in situ. Adult split-graft recipients were matched 1:2 with whole-graft recipients (matching criteria: BMI, MELD, year of transplantation, age), and matched to the paediatric recipient transplanted from the same donor. Post-LT complications were classified according to the Clavien scale. Among children, 32 split- and 31 whole-graft recipients were analysed. Among adults, 20 split- and 40 matched whole-graft recipients were analysed. In both populations, the post-operative complications did not differ between split- and whole-graft recipients. There was no difference in 1-year graft and patient survival between split- and whole-graft recipients in paediatric (90% vs. 97%, 94% vs. 97%, respectively) and in adult recipients (89% in both, 89% vs. 92%, respectively). In the analysis of both recipients issued from the same donor, there was no association in the prevalence and severity of complications. A case-by-case analysis showed that split mortality was unrelated to LT in all but one patient (small-for-size left split graft). In the setting of careful donor selection, recipient matching and surgical skill, in situ split LT is an effective and safe technique to increase the number of available organs, and split livers should no longer considered marginal grafts.

Outcome following right‐extended split liver transplantation in the recent transplant era: Single‐center analysis of a German transplant center

“…Compared to our present findings, international data regarding split LTX show substantially shorter CIT of 8‐10 hours, mainly due to local liver graft allocation and the predominance of in‐house splitting with implantation of both liver grafts at the same center . It is possible to reduce the CIT to 6 hours using strict cenrer‐oriented allocation and in situ liver graft splitting . However, application of such a process is not possible in Germany due to the existing transplant situation.…”

“…6,13,14 It is possible to reduce the CIT to 6 hours using strict cenrer-oriented allocation and in situ liver graft splitting. 15 The overall number of split LTX in Germany is low, ranging between 30 and 60 split LTX/year during the last 10 years, with half as much splitting procedures. 16 Based on 21 liver transplant centers in Germany this results in a number centers performing only single or very few splitting procedures with resulting lack of practice.…”

Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg

“…There have been multiple studies demonstrating the comparable graft and patient survival with SL grafts compared with WL grafts . Our results are unique in that it demonstrates a specific superiority in SL grafts in regards to developing HAT in patients under 25 kg.…”

Is there an ethical obligation to split every donor liver? Scarce resources, medical factors, and ethical reasoning

“…In contrast, several studies show that SLT now has the potential to achieve outcomes similar to those of WLT if several factors are taken thoroughly into account . The question is therefore no longer whether, but under what conditions SLT is able to achieve results similar to those of WLT .…”