Ex Situ Preparation of Left Split-Liver Grafts With Left Vascular Pedicle Only: Is it Safe?

Abstract

The procurement of left-lateral-segment grafts from living donors for transplantation in children is performed by retaining only the left branches of the artery and veins. New techniques and the implementation of microsurgery in the transplant operation made this procedure a successful approach. However, controversy persists about using such an approach for division of liver grafts from cadaveric donors, and many teams prefer retaining the main arterial trunk with the left split graft, with or without the main portal vein trunk. Since 1998, in our center, when a donor-liver graft is divided we prefer retaining the main vessels with the right split graft if graft vascular anatomy is favorable. After 1998, 40 liver grafts from cadaveric donors were divided, and all divisions were performed ex situ. This experience was retrospectively reviewed to compare the outcome of left split grafts prepared for implantation with the left vasculature only (group A), or with the main arterial supply (group B). A single vascular complication occurred (one hepatic artery thrombosis in group B). Three patients died (one in group A and two in group B) and three other grafts were lost (one in group A and two in group B). One-year and 3-year graft survival rates were 94% and 86% in group A, and 83% and 83% in group B, respectively (not significantly [NS] different). We conclude that left split grafts can be safely transplanted with the left vascular supply only, provided that division is guided by careful anatomical evaluation and that vascular reconstructions are adequate.

Feasibility and Limits of Split Liver Transplantation From Pediatric Donors

“…Most groups demonstrated that by maintaining the entire length of the celiac axis in continuity with the right grafts organ sharing among centers is improved without worsening patient and graft outcomes. 3,11,16,30 Other authors 6,31 showed that maintenance of the celiac trunk with the left-sided allograft does not increase the overall incidence of HAT and avoids the need for a left hepatic artery microvascular anastomosis. The recent literature reports an incidence of vascular complications of around 10%.…”

Split-Liver Transplantation: Results of Statewide Usage of the Right Trisegmental Graft

“…SLT has been shown to be an effective procedure in which to safely expand the donor pool for adults and children. The efficacy of LLS for children has been well documented in several centers in Europe (5,13). Reported use of LLS grafts from the United States has been from just a few centers (9, 11).…”

Roux‐en‐Y hepatico‐jejunostomy for a left segmental graft: Do not twist the loop, stick it!

“…The 43 grafts obtained from a DD had either only the left hepatic arterial support (16 grafts, a single artery in all cases) or were procured in continuity with the main arterial trunk (celiac trunk or common hepatic artery) ; and in the other 27 cases, a double anastomosis was conducted in only one of the latter group. The biliary drainage of the latter 43 LSG patients consisted of a single BD in 31 cases, a double in 11 cases, and a triple in two cases.…”