Transplantation of Two Patients with One Liver

Abstract

Surgical reduction of donor livers to treat small children has been performed successfully in several centers. While this procedure improves the allocation of livers, it does not increase the organ supply. We have extended reduced-size orthotopic liver transplantation (OLT) to treat 18 patients with 9 livers, accounting for 26% of our transplants during a 10-month period and have evaluated the results. In 18 split liver OLTs, patient survival was 67% and graft survival was 50%. In comparison, for 34 patients treated with full-size OLT during the same period, patient survival was 84% (p = 0.298) and graft survival was 76% (p = 0.126). Biliary complications were significantly more frequent in split grafts, occurring in 27%, as compared to 4% in full-sized grafts (p = 0.017). Primary nonfunction (4% versus 5.5%) and arterial thrombosis (6% versus 9%) occurred with similar frequency in split and full-size OLT (p = not significant). These results demonstrated that split-liver OLT is feasible and could have a substantial impact in transplant practice. We believe that biliary complications can be prevented by technical improvements and that split-liver OLT will improve transplant therapy by making more livers available.

Extensive Use of Split Liver for Pediatric Liver Transplantation: A Single-Center Experience

“…13,16,17,19,24 Arterial complications in our patients (9%) were in this range. Recent series reported a lower incidence of arterial occlusion (0% to 6%) obtained with the use of microsurgical techniques.…”

“…The overall patient and graft survival rates of our series of in situ split-liver transplantations showed an improvement over the ex situ pediatric split-liver transplantation experience. 5,[17][18][19][20][21][22][23] By in situ splitting of the liver, we were able to have short ischemia times, resulting in good liver allograft function and a low incidence of PNF. The sharing of the 2 split grafts between 2 centers allowed the transplantation of both at approximately the same time, with a reduction of the ischemic time compared with sequential transplantation, which is sometime performed in a single center.…”

“…The incidence of biliary complications varied in several reports, from 0% to 28% in pediatric split-liver transplantation 14,17,[19][20][21]28 and 10% to 38% in pediatric living related liver transplantation. [29][30][31][32] This seems to be related to the technical and anatomic problems associated with the procedure 33 and ischemic injury caused by prolonged cold preservation, 27 especially in the ex situ technique; hepatic artery thrombosis [32][33][34] ; sepsis 33 ; and underlying pathological conditions.…”

“…32 Several measures have been proposed to reduce the incidence of biliary complications: reduce cold ischemia time, 34 extensively use bench cholangiography to identify anomalous biliary anatomy, 14,19 meticulous ligation of bile duct radicles on the cut surface, 14 routinely use T-tubes, 14 and avoid the dissection of the bile duct bifurcation. 17,19,29 We did not use bench cholangiography because it increases the benching time and needs manipulation of the graft. In our series, preservation time was limited, and we did not observe a difference in cold ischemia time between patients who developed and did not develop strictures of the bile ducts (383 Ϯ 79 v 384 Ϯ 101 minutes in the entire population, respectively; 380 Ϯ 157 v 339 Ϯ 82 minutes in the split-liver group, respectively).…”

Split-Liver Transplant for Two Adults in a Spanish Hospital

“…It was developed to increase the number of grafts for the pediatric population, while its use was not justified for adults given the disappointing initial results [1]. Currently, its use is justified because of the good results obtained when there is adequate selection of the donor, the recipients, and the technical preparation; the shortage of donors; and the mortality of patients on the waiting list [2].…”