Split liver transplantation: Will it ever yield grafts for two adults?

Quintini, Cristiano; Aucejo, Federico; Miller, Charles M.

doi:10.1002/lt.21564

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…This re-transplantation situation required a long time for dissection because of severe adhesion and massive bleeding, thus the CIT was prolonged to 544 minutes. She suffered from primary non-function and had to undergo a third LT. Minimization of CIT was reported as a major contributing factor for graft loss in SLT [ 22 ]. Potential recipients requiring a long operation time for whom a difficult operation is anticipated should not be included as SLT candidates.…”

Section: Discussionmentioning

confidence: 99%

In Situ Split Liver Transplantation for 2 Adult Recipients: A Single-Center Experience

et al. 2017

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BackgroundSplit liver transplantation (SLT) for 2 adult patients by in situ splitting is rarely reported. This study analyzed the outcomes of SLT for 2 adult recipients at a single center.Material/MethodsFrom 2003 to 2014, we performed 16 adult SLTs from 8 deceased donors using in situ splitting technique. We investigated the results of SLT and compared the outcomes of SLT with those of 393 cases of primary whole liver transplantation (WLT).ResultsAll SLT donors were male. Eight recipients received right liver graft. Seven recipients received left liver graft. One recipient received dual-donor liver transplantation with 2 left-liver grafts (1 left liver graft from a living donor). The mean age of the recipients was 49.6±7 years. The Model for End-Stage Liver Disease (MELD) score of the recipients was 21.3±8.6. The mean cold ischemic time was 345.6±311.7 minutes. Graft and patient survival rates were 75.0% and 81.3%, respectively, at both 1 year and 5 years. There were 2 cases of biliary complication and 3 cases of vascular complication, but no incidence of arterial complication or small-for-size graft syndrome. The donor age of the SLT group was younger than that of the WLT group (p<0.001). The MELD score of the SLT group was lower than that of the WLT group (p=0.01). Patient and graft survival rates did not differ significantly between the SLT and WLT groups (p=0.47 and p=0.78, respectively).ConclusionsIn situ SLT for 2 adults is a feasible option to expand door pools in selected situations.

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Section: Discussionmentioning

confidence: 99%

In Situ Split Liver Transplantation for 2 Adult Recipients: A Single-Center Experience

et al. 2017

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“…Although LDLT is increasingly performed to overcome the shortage of liver donations for transplantation, splitting the liver into 2 hemi-liver grafts could be another promising strategy to maximize organ donation from a deceased donor and increase the donor pool for LT. The answer to whether 1 plus 1 equals 2, in terms of SPLT, might be obvious and sadly “no.” [ 64 , 65 ] However, splitting the liver graft can undoubtedly increase graft availability and potentially increase the number of adult transplant recipients. Although few reports have reported unsatisfactory results, SPLT should not be discouraged because of the considerably high incidence of patient mortality in the wait-list.…”

Section: Optimization Of Splt Programmentioning

confidence: 99%

“…The answer to whether 1 plus 1 equals 2, in terms of SPLT, might be obvious and sadly "no." [64,65] However, splitting the liver graft can undoubtedly increase graft availability and potentially increase the number of adult transplant recipients. Although few reports have reported unsatisfactory results, SPLT should not be discouraged because of the considerably high incidence of patient mortality in the wait-list.…”

Section: Optimization Of Splt Programmentioning

confidence: 99%

A review of split liver transplantation with full right/left hemi-liver grafts for 2 adult recipients

Chan¹,

Hung²,

Lee³

et al. 2021

Medicine

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Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split liver transplantation (SPLT), which divides a deceased donor liver into 2 partial liver grafts, is a promising strategy for increasing graft availability for transplantation and ameliorating organ shortage to a certain degree. However, the transplantation community has not yet reached a consensus on SPLT because of the variable results. Specifically, SPLT for 2 adult recipients using full right/left hemi-liver grafts is clinically more challenging in terms of surgical technique and potential postoperative complications. Therefore, this review summarizes the current status of SPLT, focusing on the transplantation of adult recipients. Furthermore, the initiation of the SPLT program, donor allocation, surgical aspects, recipient outcomes, and obstacles to developing this procedure will be thoroughly discussed. This information might help provide an optimal strategy for implementing SPLT for 2 adult recipients among current transplantation societies. Meanwhile, potential obstacles to SPLT might be overcome in the near future with growing knowledge, experience, and refinement of surgical techniques. Ultimately, the widespread diffusion of SPLT may increase graft availability and mitigate organ donation shortages.

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