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

Abstract

The role of split-liver transplantation (SLT) for two adult recipients is still a matter of debate, and no agreement exists on indications, surgical techniques, and results. The aim of this study was to retrospectively analyze the outcome of our series of SLT. From May 1999 to December 2006, 16 patients underwent SLT at our unit. We used 9 full right grafts (segments 5-8) and 7 full left grafts (segments 1-4). The splitting procedure was always carried out in situ with a fully perfused liver. Postoperative complications were recorded in 8 (50%) patients: 5 (55%) in full right grafts and 3 (43%) in full left grafts. No one was retransplanted. After a median follow-up of 55.82 months (range, 0.4-91.2), 5 (31%) patients died, and the 1-, 3-, and 5-year overall survival rate for patients and grafts was 69%. We considered as a control group for the global outcome 232 whole liver transplantations performed at our unit in the same period of time. Postoperative complications were recorded in 53 (23%) patients, and after a median follow-up of 57.37 months (mean, 55.11; range, 1-102.83), the 1-, 3-, and 5-year overall patient survival was 87%, 82%, and 80%, respectively. In conclusion, SLT for two adult recipients is a technically demanding procedure that requires complex logistics and surgical teams experienced in both liver resection and transplantation. Although the reported rate of survival might be adequate for such a procedure, more efforts have to be made to improve the short-term outcome, which is inadequate in our opinion. The true feasibility of SLT for two adults has to be considered as still under investigation.

Split Liver Transplantation Using Hemiliver Graft in the MELD Era: A Single Center Experience in the United States

“…Accumulation of worldwide experience has improved the feasibility of SLT using hemiliver grafts (3)(4)(5)(6)(7)(8)11,13,(15)(16)(17)(18)(19)(20)(21)(22). However, wide dissemination of this technology has been hindered by various challenges.…”

“…And while hemiliver SLT in the past may have led to less favorable results, it allows more adults the opportunity to receive a liver transplant (16,19,21). In order to justify more frequent use of this procedure, it is imperative to achieve results comparable to those achieved with whole liver transplantation and living donor liver transplantation (28,43,44).…”

“…The incidence of severe portal hypertension tended to be lower in the secondary recipients, but there was no statistical significance (58% vs. 23%, p ¼ 0. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] vs. 15 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], p ¼ 0.28) and listing MELD scores (22 [14][15][16][17][18][19][20][21][22][23][24][25]…”

“…In order to expand the donor pool for adults, this technique has been further expanded to use two hemiliver grafts: a left lobe and a right lobe. While SLT using hemiliver grafts can theoretically increase the number of available organs, many challenges have precluded efficient diffusion of this technique (15,16,21,23).…”

“…Many transplant centers are reluctant to use hemiliver grafts due to unfavorable outcomes and various challenges (16,19,21). First, technical challenges are a major obstacle.…”