Extensive use of split liver for pediatric liver transplantation: a single-center experience.
The results of the extensive use of in situ liver splitting in a pediatric liver transplant program are presented. All referred donors were considered for split liver, and when the donor-recipient body weight ratio (DRWR) was greater than 2, the grafts were split. A modified split-liver technique was adopted when the DRWR was 2 or less. Eighty liver procurements were attempted and 72 (90%) were performed, enabling 65 children to receive 42 split, 22 whole, and 8 reduced-size livers. The right portions of the grafts were transplanted by other centers into adults. Median patient waiting time was 22 days, with no mortality on the waiting list. After a median follow-up of 14 months, overall patient and graft survival rates were 85% and 81%, respectively. Fifty-eight children received a single allograft, whereas 7 children required retransplantation. Two-year actuarial survival rates were 85% for split-liver recipients, 84% for whole-liver recipients, and 67% for reduced-size liver recipients. Vascular complications developed in 18% of the patients, with no difference among the 3 groups with different technique. Biliary complications developed in 25% of the children, mainly in reduced-size and split-liver recipients. Patient and graft survival rates for right split-liver grafts were 84% and 79%, respectively. Adopting a liberal policy of liver splitting provides allografts of optimal quality for pediatric transplantation, allowing a dramatic decrease in the waiting list time. The in situ split-liver technique should be considered the method of choice for expanding the cadaveric liver donor pool.
Liver Transplantation Center, Ospedali Riuniti di Bergamo, Bergamo, Italy. mspada@ospedaliriuniti.bergamo.it
M
M
Spada
B
B
Gridelli
M
M
Colledan
A
A
Segalin
A
A
Lucianetti
W
W
Petz
S
S
Riva
G
G
Torre
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001835:Body Weight; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D011182:Postoperative Care; D012307:Risk Factors; D016019:Survival Analysis