Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease

Abstract

SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.

Feasibility and Limits of Split Liver Transplantation From Pediatric Donors

“…Overall, they were similar to those reported in the largest singlecenter series of conventional SLT, without distinction between donor age categories, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and to those obtained with other techniques (ie, cadaveric WLT and living-donor transplantation). 11,16 Recipients from donors weighing Յ40 kg, adult recipients, and recipients of ERG had less favorable outcomes than recipients from donors Ͼ40 kg, pediatric recipients, and recipients of LLS, respectively.…”

“…The recent literature reports an incidence of vascular complications of around 10%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Transplant centers performing SLT with maintenance of the celiac axis with the ERG frequently had an incidence of vascular complications above 10% with the "disadvantaged" LLS, whereas our overall data are within the range of 3% to 15% more commonly observed. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Although some caution is needed when evaluating the use of ERGs from very small pediatric donors, we think that the implementation of organ sharing probably remains the only fundamental issue favoring the preservation of the celiac trunk with right grafts.…”

“…Conventional SLT has gained widespread acceptance as a safe method of generating 2 grafts, usually for one pediatric and one adult recipient. Although recent results have proved satisfactory as shown by single-center experiences, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] outcomes vary greatly from one center to another, and are often inferior to WLT or living-donor liver transplantation. 3 One study conducted to compare the life expectancy of a large population of patients included in the U.S. Scientific Registry of Transplant Recipients recently demonstrated the "societal" benefit of SLT, but also a higher probability of graft loss with SLT with respect to WLT.…”

“…2,3 Recent singlecenter series of either in situ or ex situ SLT reported results comparable to whole liver transplantation (WLT). [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The ideal split liver donor should be between 14 and 50 years of age, with good liver function, serum sodium level Ͻ160 mmol/L, short intensive care unit (ICU) stay, stable hemodynamics, and with a grossly normal liver. 15,17,18 It has been shown that conventional splitting can yield a 15% increase in the number of grafts when donors within the above criteria are selected, and a 43% increase if donors with only one missing criterion are included.…”

Splitlebertransplantation

“…>80% nach einem Jahr) und damit vergleichbar sowohl mit der Transplantation von ganzen Organen wie auch von Teillebern nach Lebendspende [17,19]. [14]. Prinzipiell sollte somit in erster Linie die Splitlebertransplantation für einen kindlichen Empfänger in Betracht gezogen werden, wie dies bereits von anderen Gruppen vorgeschlagen wurde [1,17].…”