A Prospective Policy Development to Increase Split-Liver Transplantation for 2 Adult Recipients

Aseni, Paolo; Feo, Tullia Maria De; Carlis, Luciano De; Valente, Umberto; Colledan, M.; Cillo, Umberto; Rossi, G.; Mazzaferro, Vincenzo; Donataccio, M.; Fazio, Nicola; Andorno, Enzo; Burra, Patrizia

doi:10.1097/sla.0b013e31827da6c9

Cited by 55 publications

(71 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The growing discrepancy between the number of available organs and the number of liver transplant candidates is an incentive for innovative surgical techniques such as split‐graft LT. If the split technique is well accepted for children, who lack size‐matched organs, fears of inferior results in adults still persist . The splitting procedure is associated with supposed or real challenges: a small‐for‐size graft, a cut surface prone to leaks and more difficult vascular and biliary reconstructions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Moussaoui

Toso

Nowacka

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

Split-liver transplantation (LT) allows transplantation of two recipients from one deceased donor, thereby increasing pool of grafts. However, split LT may be hampered by technical problems, and split grafts are still considered suboptimal organs in some centres. We analysed the outcomes in split- and whole-liver recipients in a combined adult-to-paediatric transplantation programme. Records of paediatric and adult patients having undergone LT from 1999 to 2013 were analysed retrospectively. All splits were performed in situ. Adult split-graft recipients were matched 1:2 with whole-graft recipients (matching criteria: BMI, MELD, year of transplantation, age), and matched to the paediatric recipient transplanted from the same donor. Post-LT complications were classified according to the Clavien scale. Among children, 32 split- and 31 whole-graft recipients were analysed. Among adults, 20 split- and 40 matched whole-graft recipients were analysed. In both populations, the post-operative complications did not differ between split- and whole-graft recipients. There was no difference in 1-year graft and patient survival between split- and whole-graft recipients in paediatric (90% vs. 97%, 94% vs. 97%, respectively) and in adult recipients (89% in both, 89% vs. 92%, respectively). In the analysis of both recipients issued from the same donor, there was no association in the prevalence and severity of complications. A case-by-case analysis showed that split mortality was unrelated to LT in all but one patient (small-for-size left split graft). In the setting of careful donor selection, recipient matching and surgical skill, in situ split LT is an effective and safe technique to increase the number of available organs, and split livers should no longer considered marginal grafts.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Aseni et al . reported a lower patient and graft survival rate in adults with split‐graft vs whole‐graft recipients, but focusing on full‐right and full‐left grafts, a fact which might lead to different outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Moussaoui

Toso

Nowacka

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…Twenty percent of patients in Europe and 14% in the United States die while waiting for a liver [1]. One possible way to reduce the waiting list mortality is splitting full livers into hemilivers; this procedure would allow transplantation in 2 adult recipients by using a single organ from a deceased donor.…”

mentioning

confidence: 99%

Split-Liver Full-Left Full-Right: Proposal for an Operative Protocol

Ferla¹,

Lauterio²,

Sandro³

et al. 2014

Transplantation Proceedings

View full text Add to dashboard Cite

“…Aseni et al[28] reported a recent Italian multicenter experience of hemiliver SLT, showing inferior 5-year survival compared to whole liver transplantation (63% vs 83%). However, under certain circumstances, long-term survival after hemiliver SLT is equivalent to whole liver transplantation or LDLT[9,10,12,29].…”

Section: Discussionmentioning

confidence: 99%

Split liver transplantation in adults

Hashimoto¹,

Fujiki²,

Quintini³

et al. 2016

WJG

View full text Add to dashboard Cite

Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues.

show abstract

A Prospective Policy Development to Increase Split-Liver Transplantation for 2 Adult Recipients

Abstract: AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

Cited by 55 publications

References 37 publications

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Early complications after liver transplantation in children and adults: Are split grafts equal to each other and equal to whole livers?

Split-Liver Full-Left Full-Right: Proposal for an Operative Protocol

Split liver transplantation in adults

Contact Info

Product

Resources

About