title: In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool.
abstract: OBJECTIVE
  The authors evaluate the safety, applicability, and effectiveness of a new technique for split-liver transplantation.
  
  
  BACKGROUND
  Split-liver transplantation offers an attractive way to increase the donor pool for cadaveric liver transplantation. The application of this concept has been hampered by inferior patient and graft survivals and higher complication rates. Without supportive data, the concern about increasing biliary leakage and poor initial graft function persisted. The authors focused on the causes of these complications by presenting a new technique to eliminate these problems.
  
  
  METHODS
  Liver splitting was performed in the heart-beating cadaveric organ donor, using the technique described for procurement of the left lateral lobe of a live donor. A detailed description of the technique is presented. A retrospective review of the first 14 transplantations resulting from 7 in situ splitting procedures was collected. The results were compared with 19 conventional split-liver transplants performed during the same period.
  
  
  RESULTS
  Six-month patient and graft survivals after in situ split-liver transplantation were 92.8% and 85.7%, respectively. Biliary complications were absent. Postoperative courses were mostly uneventful and characterized by lower peak transaminase levels compared with standard techniques. Early graft function of extrahepatic organs procured simultaneously was excellent.
  
  
  CONCLUSIONS
  In situ split-liver transplantation provides superior results, related mainly to reduction of cold ischemic damage of the grafts and avoidance of biliary complications. In situ split-liver transplantation renders graft reduction alone obsolete and opens a donor pool for adults to receive right lobes safely. It allows for long-distance sharing between pediatric and adult liver transplant units because the procedure abolishes ex situ benching and prolonged ischemia time and provides two anatomically perfect grafts with hemostasis accomplished.
authors.affiliation: Department of Surgery, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: X
authors.initials: X
authors.lastname: Rogiers
authors.forename: M
authors.initials: M
authors.lastname: Malagó
authors.forename: K
authors.initials: K
authors.lastname: Gawad
authors.forename: K W
authors.initials: KW
authors.lastname: Jauch
authors.forename: M
authors.initials: M
authors.lastname: Olausson
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: M
authors.initials: M
authors.lastname: Gundlach
authors.forename: A
authors.initials: A
authors.lastname: Bassas
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Sterneck
authors.forename: M
authors.initials: M
authors.lastname: Burdelski
authors.forename: C E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods*