Outcomes With Split Liver Transplantation in 106 Recipients

Vagefi, Parsia A.; Parekh, Justin; Ascher, Nancy L.; Roberts, John P.; Freise, Chris E.

doi:10.1001/archsurg.2011.218

Cited by 87 publications

(43 citation statements)

References 15 publications

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“…Nevertheless, excellent long-term results are reported in the case of extended right/left lateral splitting, with 10% surgical revisions in adult and 28% in pediatric recipients. No significant differences between in situ and ex vivo splitting were observed (86). The risk of bile leaks from the cutsurface is higher than after LDLT; e.g.…”

Section: Special Issues In Split and Pediatric Liver Transplantationmentioning

confidence: 79%

“…These include cut-surface leaks due to unclosed or aberrant bile ducts and necrosis of liver tissue, mainly of segment 4 in the case of asymmetric splitting. Biliary complications are reported in 29% of adult and 40% of pediatric recipients of partial liver grafts (86). Nevertheless, excellent long-term results are reported in the case of extended right/left lateral splitting, with 10% surgical revisions in adult and 28% in pediatric recipients.…”

Section: Special Issues In Split and Pediatric Liver Transplantationmentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

258

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Special Issues In Split and Pediatric Liver Transplantationmentioning

confidence: 79%

Section: Special Issues In Split and Pediatric Liver Transplantationmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

258

233

View full text Add to dashboard Cite

show abstract

“…While living-donor liver donations (LDLT) provide a means to expand organ availability, stringent donor and recipient selection criteria, and concerns over donor complications, have kept the number of LDLT transplants relatively low [88]. Other approaches to expanding the donor-organ supply have included donation after cardiac death [89,90], the use of hepatitis C-and hepatitis B-positive donors [91][92][93], and split-liver transplantations [94,95]. Split-liver transplantation involves splitting adult donor livers into left lateral and extended right grafts for transplantation into both a pediatric and adult patient [94].…”

Section: Liver Transplantationmentioning

confidence: 99%

“…Split-liver transplantation involves splitting adult donor livers into left lateral and extended right grafts for transplantation into both a pediatric and adult patient [94]. Outcomes of this technique have been comparable with whole-graft transplantation, and increasing the use of this technique could increase the total number of transplant recipients in the United States by 1000 annually [95]. Despite these recent attempts to alleviate donor-organ shortage, almost two-thirds of people waiting for a donor liver never receive one.…”

Section: Liver Transplantationmentioning

confidence: 99%

Translational Regenerative Medicine—Hepatic Systems

Dhal

Vyas

Moran

et al. 2015

Translational Regenerative Medicine

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“…Invariably, the outcomes of SLT are dependent on the technical success and adaptations of both the splitting and transplantation procedures. 6 The lack of systematic analysis of outcomes from a technical reconstruction point of view is an issue. It is important to recognize whether a particular reconstruction technique is more risky and could potentially jeopardize a right lobe graft in comparison with other techniques.…”

mentioning

confidence: 99%

Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques

et al. 2014

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Split liver transplantation (SLT) compensates for the organ shortage and provides an alternative solution for recipients disadvantaged by a smaller body size. Variations in the hepatic arterial anatomy and reconstructive techniques may lead to more technical complications, and we sought to analyze the incidence and risk factors of vasculobiliary complications with respect to reconstructive techniques. We identified 171 adult right lobe SLT procedures and 1412 whole liver transplantation (WLT) procedures between January 2000 and June 2012 and compared the results of these 2 groups. In the SLT group, arterial reconstruction techniques were classified into 4 subgroups (I-IV), and biliary reconstruction was classified into 2 groups [duct-to-duct (DD) anastomosis and Roux-en-Y hepaticojejunostomy (RH)]. Specific surgical complications were analyzed against reconstruction techniques. The overall incidence of vascular and biliary complications in the SLT group was greater than that in the WLT group (P 5 0.009 and P 5 0.001, respectively). There was no difference in hepatic artery thrombosis (HAT), but we saw a tendency toward early HAT in the presence of multiple hepatic arteries supplying the right lobe graft (group IV; 20%) in comparison with the other arterial reconstruction groups (P 5 0.052). No difference was noticed in the overall incidence of biliary complications in either DD or RH recipients across 4 arterial reconstruction groups. When the arterial reconstruction involved a right hepatic artery (groups II and III) combined with a DD biliary anastomosis, there was a significant preponderance of biliary complications (P 5 0.04 and P 5 0.01, respectively). There was no survival difference between SLT and WLT grafts. In conclusion, the complications of SLT are directly related to arterial and biliary reconstruction techniques, and this classification helps to identify highrisk reconstructive techniques.

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Outcomes With Split Liver Transplantation in 106 Recipients

Abstract: Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients.

Cited by 87 publications

References 15 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Translational Regenerative Medicine—Hepatic Systems

Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques

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