The Use of Reduced-Size Liver Transplants in Children, Including Split Livers and Living Related Liver Transplants

Abstract

One of the key problems facing children awaiting liver transplantation is the shortage of donor organs. Surgical procedures that address this problem include: reduced-size liver transplantation (RLT), split liver transplantation (SLT), and living related liver transplantation (LRLT). RLT makes more of the current donor pool accessible to the pediatric recipient. SLT furnishes 2 liver grafts from 1 cadaveric donor, and LRLT provides an innovative supply of donor organs. This report compares the results achieved with RLT, SLT, and LRLT to those seen with full-size orthotopic liver transplantation (OLT). Between November 1984 and February 1991, 457 liver transplants were performed at the University of Chicago. Two hundred fourteen of these transplants were placed into recipients less than 13 years of age. Of these 214 pediatric orthotopic liver transplants (OLT), 103 were full-size livers and 111 were some type of reduced graft (RLT, SLT, or LRLT). There were 57 RLT, 34 SLT, and 20 LRLT. The recipients of the reduced grafts (RLT, SLT, or LRLT) averaged 1.9 +/- 1.8 years of age and 9.6 +/- 6.4 kg compared to the recipients of the full-size livers who averaged 3.5 +/- 3.4 years of age and 14.1 +/- 8.8 kg (p = 0.0001). The most common indication for transplantation was biliary atresia (105 patients). Overall patient survival after primary full-size OLT was 71.8%. Reduced-size OLT (RLT, SLT, and LRLT) resulted in an overall patient survival of 72.6% after primary transplantation. Patient survivals for primary transplants with specific types of reduced-size grafts were: RLT 76.5% (after RLT was used routinely), SLT 66.7%, and LRLT 89.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcomes for pediatric liver retransplantation from living donors

“…Since the first success of LDLT in 1989 (17)(18)(19), LDLT has become accepted worldwide as a viable treatment option for patients with end-stage liver disease. Although the advantages and disadvantages of LDLT have been discussed (20 -23), issues regarding retransplantation from living donors have previously been largely ignored.…”

Predicted Lifetimes for Adult and Pediatric Split Liver Versus Adult Whole Liver Transplant Recipients

“…In this procedure, termed partial or reduced size liver transplantation, the left lateral segment or left lobe of the donor liver is used, and the remaining hepatic parenchyma is discarded. By 1993, several reports appeared describing techniques of split liver transplantation (5)(6)(7)(8). The application of split liver transplantation increases the donor pool for all patients on the liver transplant waiting list by giving a partial graft to 2 patients instead of a whole organ to 1 adult or a partial graft to 1 child.…”

Milestones in the evolution of hepatic surgery

“…When liver surgeons began performing transplantation, liver resection was a step in the procedure. Surgery on the graft itself or on the recipient, which may have meant heterotopic liver transplantation and reducing the size of the graft,66,67 operating on the living donor,68 performing a domino transplantation,69,70 or a split liver procedure,71–74 were all done by liver surgeons doing liver transplantation.…”