BACKGROUND: The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial. METHODS: From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV). RESULTS: Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P= 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively. CONCLUSIONS: Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.
BACKGROUND: The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial. METHODS: From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV). RESULTS: Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P= 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively. CONCLUSIONS: Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.
Authors: D Azoulay; D Castaing; R Adam; E Savier; V Delvart; V Karam; B Y Ming; M Dannaoui; J Krissat; H Bismuth Journal: Ann Surg Date: 2001-04 Impact factor: 12.969
Authors: Abhinav Humar; Joy Beissel; Shaina Crotteau; Raja Kandaswamy; John Lake; William Payne Journal: Transplantation Date: 2008-05-27 Impact factor: 4.939
Authors: Hasan Yersiz; John F Renz; Douglas G Farmer; Garrett M Hisatake; Suzanne V McDiarmid; Ronald W Busuttil Journal: Ann Surg Date: 2003-10 Impact factor: 12.969
Authors: Harald Schrem; Moritz Kleine; Tim Oliver Lankisch; Alexander Kaltenborn; Lampros Kousoulas; Lea Zachau; Frank Lehner; Jürgen Klempnauer Journal: World J Surg Date: 2014-07 Impact factor: 3.352