Outcome of other organs recovered during in situ split-liver procurements

Abstract

Split-liver transplantation is becoming a useful technique to expand the donor pool. Whether the split should be performed in situ or ex situ is not clear. One potential disadvantage of in situ splits is that prolonged surgical time and increased blood loss may negatively affect the function of other solid organs (kidneys, pancreas, and heart) procured from the same donor. Therefore, we studied the function of other organs posttransplantation. Between September 1, 1999, and March 31, 2000, we performed six in situ splits at the University of Minnesota (Minneapolis, MN). These six splits yielded six right-lobe liver grafts and six left-lobe liver grafts, which were transplanted into 12 adult-size recipients. Other grafts obtained from these six donors were as follows: kidney (n ‫؍‬ 11), heart (n ‫؍‬ 4), lungs (n ‫؍‬ 1), pancreas (n ‫؍‬ 2), and kidney-pancreas (n ‫؍‬ 1). We then analyzed posttransplantation function of these grafts and the postoperative course of transplant recipients. All six donors were hemodynamically stable at the time of procurement. Mean donor age was 19.7 years. Mean surgical time for the procurement was 7.4 hours, with an average blood loss of 490 mL during in situ splitting of the liver. The 12 liver grafts showed good initial function with no primary nonfunction. The other organs also showed good function. Of 11 kidney recipients, only 1 patient developed delayed graft function, which resolved within 4 days. In addition, 1 kidney was lost early because of severe acute rejection. For the 10 recipients with functioning kidneys, mean creatinine level at hospital discharge was 2.0 mg/dL, and mean creatinine level after an average 9-month follow-up was 1.3 mg/dL. Of the 4 heart transplant recipients, 3 patients had good graft function immediately posttransplantation, with an ejection fraction greater than 60%, minimal inotropic requirements, and no surgical complications. The fourth heart transplant recipient, a critically ill status 1 patient, had poor initial function and a prolonged intensive care unit stay. At hospital discharge, pancreas and pancreas-kidney transplant recipients were all insulin free, with good urine amylase levels, no surgical or infectious complications, and no evidence of significant pancreatitis posttransplantation. The kidney of the pancreas-kidney transplant recipient functioned immediately; creatinine level after 7 months of follow-up was 1.2 mg/dL. Despite increased surgical time and blood loss, in situ splitting of liver grafts can be accomplished in stable donors without significant negative effects on other organs. (Liver Transpl 2001;7:853-857.) S everal approaches currently are used to help alleviate the shortage of donor livers, including the use of living donors, splitting of cadaver livers, and use of cadaver donors considered marginal in quality. 1 Living donor liver transplantation has gained popularity in the last decade; however, significant concern persists regarding short-and long-term complications for the donor. 2 Split-liver transplants (SLTs), f...

Should we still offer split-liver transplantation for two adult recipients? A retrospective study of our experience

“…The liver parenchymal transection can be done in situ or ex situ 45, 46 . In situ splitting allowed us to have a shorter cold ischemic time, meticulous control of the graft perfusion before the final division, and minimal bleeding from the cut surface on reperfusion.…”

Split-Liver Transplantation: A Review

“…Increased logistics coordination is necessary, but SLT can routinely be performed without special equipment or impedance of thoracic or additional abdominal organ procurements (20,21). In situ separation reduces cold ischemia, simplifies identification of biliary and vascular structures (18,22), eliminates unintentional graft rewarming during ex vivo manipulation, and reduces hemorrhage upon graft reperfusion (22,23).…”

Optimizing the use of donated cadaver livers: Analysis and policy development to increase the application of split-liver transplantation

“…On the other hand, the prolonged dissection required to prepare the grafts before aortic cross clamp may be associated with increased blood loss and volume replacement and has prompted concerns from cardiac-thoracic teams that the quality of hearts and lungs may be affected. 28 Data from centers with a commitment to in situ SLT suggest the impact of the procedure is minimal, 29 though some anecdotal experiences indicate that prolonged dissection may impact other organs.…”