In Situ Split Liver Transplantation for 2 Adult Recipients: A Single-Center Experience

Abstract

BackgroundSplit liver transplantation (SLT) for 2 adult patients by in situ splitting is rarely reported. This study analyzed the outcomes of SLT for 2 adult recipients at a single center.Material/MethodsFrom 2003 to 2014, we performed 16 adult SLTs from 8 deceased donors using in situ splitting technique. We investigated the results of SLT and compared the outcomes of SLT with those of 393 cases of primary whole liver transplantation (WLT).ResultsAll SLT donors were male. Eight recipients received right liver graft. Seven recipients received left liver graft. One recipient received dual-donor liver transplantation with 2 left-liver grafts (1 left liver graft from a living donor). The mean age of the recipients was 49.6±7 years. The Model for End-Stage Liver Disease (MELD) score of the recipients was 21.3±8.6. The mean cold ischemic time was 345.6±311.7 minutes. Graft and patient survival rates were 75.0% and 81.3%, respectively, at both 1 year and 5 years. There were 2 cases of biliary complication and 3 cases of vascular complication, but no incidence of arterial complication or small-for-size graft syndrome. The donor age of the SLT group was younger than that of the WLT group (p<0.001). The MELD score of the SLT group was lower than that of the WLT group (p=0.01). Patient and graft survival rates did not differ significantly between the SLT and WLT groups (p=0.47 and p=0.78, respectively).ConclusionsIn situ SLT for 2 adults is a feasible option to expand door pools in selected situations.

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

“…However, outside of European and American centers, the use of SLT techniques has been less frequent because of the predominantly LDLT practice in the East. However, experience with SLT has been reported from centers in Taiwan, Japan, and Korea …”

Clinical Features and Clonal Origin of Diffuse Hepatocellular Carcinoma

“…Compared with the other methods, transplantation was relatively effective. [ 7 ] However, more multicenter studies are needed to confirm our results.…”

Prognosis of Split Liver Transplantation Compared with Whole Liver Transplantation in Adult Patients: Single-center Results Under the Korean MELD Score-based Allocation Policy

“…If this whole liver graft appears too large for a single selected adult recipient, it may be utilized for two-adult SLT, both to match the graft size and to expand the donor graft pool. 7 …”

“…The surgical techniques for adult-child and two-adult SLTs have been described previously in detail. 7 16 17 The usual left lateral section graft is actually an extended left lateral section graft, thus the left medial section parenchyma that is attached to the right liver does not function because all inflow vessels and bile duct are totally transected. Right trisection grafts have therefore been replaced by ERL grafts.…”

“… 5 Of the 2,462 patients in Korea who underwent DDLT from 2005 to 2014, 86 (3.5%) adult patients received split extended right liver (ERL) grafts. 6 Considering that a small number of donor liver splitting were performed for two adults, 7 the proportion of adult recipients undergoing SLT in Korea was estimated to be approximately 4%.…”