Split-Liver Transplantation: A Review

Renz, John F.; Yersiz, Hasan; Reichert, Paulo Roberto; Hisatake, Garrett M.; Farmer, Douglas G.; Emond, Jean C.; Busuttil, Ronald W.

doi:10.1046/j.1600-6135.2003.00254.x

Cited by 104 publications

(80 citation statements)

References 61 publications

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“…Grafts with liver segments II and III are transplanted into pediatric recipients, while those with segments I and IV-VIII are transplanted into adult ones ( Figure 1). According to the current literature, the split technique has good results, with survival rates similar to those obtained with whole graft transplants 6,7,12,16,17 . However, conducted from September 2009 to April 2016 including pediatric patients undergoing splitliver transplantation at Hospital São Paulo, UNIFESP.…”

Section: ■ Introductionmentioning

confidence: 70%

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Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

et al. 2017

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Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients -55.5%) than in Group B (3 patients -17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.

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Section: ■ Introductionmentioning

confidence: 70%

“…However, it is difficult to find deceased liver donors with suitable grafts for small recipients [6][7][8] . In addition to the shortage of organs for transplantation from deceased donors, the mortality of the patients in waiting lists is a concerning reality 3,9-11 .…”

Section: ■ Introductionmentioning

confidence: 99%

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

et al. 2017

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“…However, when the split procedure was used, 100 livers were enough for 152 successful transplants (76 livers were split and 24 whole livers were used for retransplantation)-leading to an aggregate of 48 extra years of life lived over patients still on the waitlist, as compared to whole liver recipients' aggregate of 40 extra years of life lived over waitlist patients (4). While Merion's study is the factual foundation for our inquiry, it should again be emphasized that there is considerable variation in results between transplant centers (3,5,6).…”

Section: Outcomes Associated With Sltmentioning

confidence: 94%

Ethical Issues in Split Versus Whole Liver Transplantation

Vulchev

Roberts

Stock

2004

American Journal of Transplantation

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IntroductionSplit liver transplantation (SLT) allows two recipients, in current practice usually an adult and a child, to benefit from one deceased donor liver. Recent comprehensive studies confirm that split liver transplants generally lead to less favorable results for individual recipients, but also lead to more individuals getting the benefit of a liver transplant. Surgeons' pioneering advances in the operating room have left a classic ethical dilemma in their wake: where and how should the transplant community draw a balance between the rights and interests of patient A (an adult recipient), who is at the top of the transplant list, and patient B (most likely a pediatric recipient), who is somewhere down the list and will get a timely liver transplant if and only if patient A shares the donor liver. The purpose of this essay is to explore this difficult issue and also to propose general ethical and policy guidelines for the use of split liver transplants vis-à-vis whole liver transplants.

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“…These are organs with high risk of complications, for instance primary dysfunction, delayed graft function or biliary complications 61 . This category incorporates organs from split livers, non-heart beating donors, elderly donors and HCV-infected donors [62][63][64][65][66] .…”

Section: Emerging Challenges In Liver Transplantationmentioning

confidence: 99%

The Evolution of Criteria for Liver Transplantation for Hepatocellular Carcinoma: From Milan to San Francisco and All Around the World!

Ziogas¹,

Tsoulfas²

2017

RFMH

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Introduction: Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third most common cancerrelated cause of death in the world. According to the stage of the disease, each patient is allocated to a different treatment option. Liver transplantation, along with surgical resection, is the only totally therapeutic option and is primarily indicated in HCC patients with underlying cirrhosis. However, the restricted number of liver grafts imposes difficulties in selecting the most suitable patients to receive those limited grafts and therefore certain criteria have been proposed. The Milan criteria are currently the most widely accepted and utilized criteria around the world, despite their restrictiveness. In an attempt to assist HCC patients exceeding them, but with a potential to display acceptable survival outcomes, undergo liver transplantation, research teams worldwide suggest expanded criteria based on their findings. Some of the most broadly known are the University of California, San Francisco (UCSF), Kyoto, Tokyo, Hangzhou and up-to-7 criteria. On the other hand, in order to expand the liver donor pool, grafts may be accepted from living, non-heart beating, elderly, steatotic, or even HCV-infected donors, in addition to the use of split livers with both advantages and disadvantages. The aim of this review is to thoroughly present the current situation of liver transplantation for HCC patients, with a focus on the criteria used and emerging challenges presented. Core tip: Hepatocellular carcinoma (HCC) is the third most common malignancy worldwide and liver transplantation represents the treatment of choice, particularly in the setting of cirrhosis. Lack of grafts led to the utilization of certain criteria in order to determine the eligibility of an HCC patient to access the waiting list. The most widely accepted are the Milan criteria, even though they are thought off as too restrictive. Consequently, transplant research groups all over the world published their own criteria, which showed acceptable outcomes. Living donor liver transplantation and other extended-criteria grafts have been proposed as an alternative to reduced donations. Ziogas IA, Tsoulfas G. The evolution of criteria for liver transplantation for hepatocellular carcinoma: from Milan to San Francisco and all around the world!

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Split-Liver Transplantation: A Review

Cited by 104 publications

References 61 publications

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Ethical Issues in Split Versus Whole Liver Transplantation

The Evolution of Criteria for Liver Transplantation for Hepatocellular Carcinoma: From Milan to San Francisco and All Around the World!

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