Feasibility and Safety of Split‐Liver Transplantation in a Nascent Framework of Deceased Donation

Abstract

Split-liver transplantation (SLT) is a valuable option for optimizing the use of good-quality deceased donor grafts. It is not routinely reported outside the West because of limited deceased donor numbers, technical and organizational constraints, lack of experience, and a predominant living donor liver transplantation (LDLT) practice. At our center, 20% of the liver transplantations (LTs) are from deceased donors. We report our experience of SLT and compare outcomes with pediatric and adult LDLT recipients. A prospectively maintained database of all LT recipients between September 2009 and March 2017 was analyzed.Each pediatric SLT recipient was matched to 2 pediatric LDLT recipients for age, weight, urgency, and year of transplant. Each adult SLT recipient was similarly matched to 2 adult LDLT recipients for age, Model for End-Stage Liver Disease score, and year of transplant. Intraoperative and postoperative parameters, including recovery time, morbidity (biliary and vascular complications, Clavien grade >IIIA complications), and mortality were compared. In total, 40 SLTs were performed after splitting 20 deceased donor livers (in situ, n = 11; hybrid split, n = 3; and ex vivo, n = 6). Recipients included 22 children and 18 adults. There were 18 livers that were split conventionally (extended right lobe and left lateral segment [LLS]), and 2 were right lobe-left lobe SLTs. Also, 3 LLS grafts were used as auxiliary grafts for metabolic liver disease. Perioperative mortality in SLT recipients occurred in 3 patients (2 children and 1 adult). Incidence of vascular, biliary, and Clavien grade >IIIA complications were similar between matched adult and pediatric SLT and LDLT groups. In conclusion, SLT is an effective technique with outcomes comparable to living donor grafts for adult and pediatric recipients. Using SLT techniques at centers with limited deceased donors optimizes the use of good-quality whole grafts and reduces the gap between organ demand and availability.

Outcomes of Pediatric Liver Transplantation in Japan: A Report from the Registry of the Japanese Liver Transplantation Society

“…Of note, we could not achieve sufficient graft survival in pediatric DDLT or split LT in comparison to LDLT in the present study. We need to learn from experienced countries regarding donor selection criteria, indications, procurement technique, preservation methods, and immunosuppression for pediatric DDLT and split LT. [27][28][29] The present study was associated with some limitations, including restrictions on information contained within the JLTS dataset, as well as the accuracy and consistency of that information. We did not have access to preoperative patient conditions, including the Pediatric End-Stage Liver Disease score, recipient or donor laboratory data, immunosuppression protocols, recipient or donor morbidity, surgical complications, and cause of death, growth, or quality of life (QOL) measures.…”

Impact of allograft types on outcomes after pediatric liver transplantation due to biliary atresia

“… 10 However, a meta‐analysis of adults revealed no differences, 11 and recent research suggested that adult recipient and allograft survival rates were similar, regardless of the allograft types used 12 . A prospective study in pediatric recipients exhibited no difference between SLT and LDLT groups 13 . As liver transplantation research in children is uncommon, and there is no standardized protocol, we herein retrospectively analyzed the impact of different allograft types on outcomes after PLT in patients with BA.…”

“…12 A prospective study in pediatric recipients exhibited no difference between SLT and LDLT groups. 13 As liver transplantation research in children is uncommon, and there is no standardized protocol, we herein retrospectively analyzed the impact of different allograft types on outcomes after PLT in patients with BA.…”

Liver transplantation for pediatric inherited metabolic liver diseases

“…The issue of scarcity of donor organs has led to optimization of the available grafts through various surgical techniques such as reduction of an adult donor graft in children, particularly through split liver grafts[ 79 ], auxiliary transplantation and the use of heterozygous donors.…”