Outcome of split‐liver transplantation from pediatric donors weighing 25 kg or less

Abstract

The lower limit of body weight for “splitable” liver grafts remains unknown. To examine the outcome of split‐liver transplantation (SLT) from pediatric donors ≤25 kg relative to conventional graft‐type liver transplantation from deceased donors under corresponding conditions, a total of 158 patients who received primary liver transplantation, including 22 SLTs from donors ≤25 kg, 46 SLTs from donors >25 kg, 76 whole‐liver transplantations, and 14 reduced‐liver transplantations in donors ≤25 kg between January 2018 and December 2019, were included in the study. There was no significant difference in the complications, patient survival, and graft survival between each of the latter three groups and the SLT ≤25 kg group. Pediatric End‐Stage Liver Disease (PELD) score was the independent predictor of graft loss (death or retransplantation). Graft weight was the independent predictor of hepatic artery thrombosis. SLT using well‐selected pediatric donors ≤25 kg is an effective strategy to increase organ availability, especially for low‐body‐weight recipients, compared with conventional graft type from deceased donors under the condition of corresponding donor weight without increasing morbidity and mortality.

Optimizing graft‐recipient size matching in adolescent liver transplantation: Don't forget ex situ right posterior sectionectomy

“…Besides morphological consideration this allows two recipients to benefit from a single graft which in the context of organ shortage 5 must remain a priority. However, performing two procedures by the same team is a logistical challenge 16 and requires having two suitable recipients on the waiting list. In addition, partial liver grafts presented with longer static cold storage, 3 a higher rate of biliary complications 17 and require more challenging implantation techniques.…”

Cell therapy in end-stage liver disease: replace and remodel

“…Due to the shortage of healthy donor livers, a wide gap exists between the number of patients on the waiting list and the number of organs available, and those waiting for organ donation have a high mortality rate [ 5 , 6 ]. Despite the emergence of novel surgical transplantation procedures such as split liver transplantation, the problem of donor liver scarcity has not been satisfactorily addressed [ 7 , 8 ]. Fortunately, cell therapy, an increasingly popular strategy for treating end-stage liver disease, can effectively address the shortage of donor livers and reduce the need for invasive surgical procedures.…”

Letter to the Editor: Reduced whole liver grafts from pediatric donors as an alternative for small recipients

“…Guillaume Rossignol 1,2,3,4 Xavier Muller 2,3,4 Remi Dubois 1 Jean-Yves Mabrut 2,3 Kayvan Mohkam 1,2,3…”

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To the editor, We read with great interest the study from Wang et al [1] on reducing the donor weight limit for split liver grafts in pediatric liver transplantation (LT). The authors described 22 split liver transplantations from donors weighing <25 kg with similar postoperative outcomes compared to other graft types.The authors were able to perform a split procedure and 2 transplantations with the same team, which is a logistical challenge.

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