title: Results of split liver transplantation in children.
abstract: OBJECTIVE
  To analyze the outcome of 80 consecutive pediatric split liver transplants performed at the authors' center between 1994 and 2000.
  
  
  BACKGROUND
  Split liver transplantation has become an accepted method of increasing the number of available grafts for pediatric liver transplant recipients.
  
  
  METHODS
  The age of the patients at the time of transplantation ranged from 5 days to 16 years (median 3 years). Sixteen transplants were performed for acute liver failure and 64 for chronic liver failure. The ex situ splitting technique was used for all but four grafts. Fourteen livers were split for two pediatric recipients. Posttransplant follow-up ranged from 6 to 84 months (median 42 months).
  
  
  RESULTS
  Overall patient survival at 6 months follow-up was 96.2%. Graft survival at six months was 93.7%. The Kaplan-Meier patient survival rates at 1 and 3 years were 93.5% and 88.1%, and the graft survival rates were 89.7% and 86.1%, respectively. Four patients required retransplantation. In the acute group (n = 16), the patient survival rates were 93.7% at 1 year and 76.4% at 3 years; there were three deaths due to posttransplant lymphoproliferative disease (PTLD), sepsis, and chronic rejection. In the chronic group (n = 64), the 1- and 3-year patient survival rates were 93.6% and 90.9%, respectively. There were six deaths in this group. Four patients died in the first year after the transplant due to intracranial bleeding, cerebral tumor recurrence, PTLD, and chronic rejection. There were two deaths at 3 years, one due to progressive renal failure secondary to cyclosporin toxicity and the other due to sepsis, portal hypertension, and recurrent bleeding. Vascular complications occurred in six (7.5%) patients and biliary complications in seven (8.7%).
  
  
  CONCLUSIONS
  These results, which represent the experience of a single institution over the last 6 years, indicate that ex situ split liver transplantation can be performed in children with good overall outcome and acceptable morbidity.
authors.affiliation: Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom.
authors.forename: Rahul R
authors.initials: RR
authors.lastname: Deshpande
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bowles
authors.forename: Hector
authors.initials: H
authors.lastname: Vilca-Melendez
authors.forename: Parthi
authors.initials: P
authors.lastname: Srinivasan
authors.forename: Raffaele
authors.initials: R
authors.lastname: Girlanda
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
authors.forename: Giorgina
authors.initials: G
authors.lastname: Mieli-Vergani
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D011183:Postoperative Complications; D016019:Survival Analysis; D016896:Treatment Outcome