The results of reduced-size liver transplantation, including split livers, in patients with end-stage liver disease.
We initiated a policy of using RSLT in critically ill patients in June of 1988. Since that time we have performed 30 RSLTs in 29 patients, including 28 children and 1 adult. The mean age of the children was 27 months (range 1 month to 10 years) with 14 (52%) being 1 year of age or less. The mean weight was 11.3 kg (range 2-50 kg) with 20 being 10 kg or less. A total of 22 patients were in the intensive care unit at the time of RSLT including 9 who were intubated. Of the 30 RSLTs, 23 were performed as a primary transplant while 7 were retransplants. Indications for primary transplantation included biliary atresia (n = 11), fulminant hepatic failure (n = 5), neonatal hepatitis (n = 4) and others (n = 3). The RSLT was used in retransplantation for primary nonfunction (n = 2), hepatic artery thrombosis (n = 2), chronic rejection (n = 2), and herpetic hepatitis (n = 1). The size reductions included 18 left lobes, 7 left lateral segments, and 5 right lobes. This group includes the use of the split-liver technique, which was applied to 10 patients (5 livers). The median donor/recipient weight ratio for left lobe transplants was 2:1; left lateral segments was 7.3:1; and right lobes 1.6:1. One year actuarial patient and graft survivals were 68 and 65%, respectively, with a mean follow-up of 10.6 months. The number of children dying awaiting transplantation has been significantly reduced following the introduction of RSLD (3 of 115, 2.6% vs. 12 of 95, 13%; P less than 0.02).
Langnas
A N
AN
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Marujo
W C
WC
Inagaki
M
M
Stratta
R J
RJ
Wood
R P
RP
Shaw
B W
BW
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001660:Biliary Tract Diseases / Q000209:etiology; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D007223:Infant; D008099:Liver / Q000033:anatomy & histology*; D008100:Liver Abscess / Q000209:etiology; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D009929:Organ Size; D013514:Surgical Procedures, Operative / Q000379:methods; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin