Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease.
BACKGROUND
End-stage cholestatic liver disease (ESCLD) is the main indication for liver replacement in children. Pediatric cadaver-organ-donor shortage has prompted the most important evolutions in the technique of liver transplantation, in particular living-donor liver transplantation (LDLT) and split-liver transplantation (SLT).


METHODS
Between November 1997 and June 2001, 127 children with ESCLD were evaluated for liver transplantation, and 124 underwent 138 liver transplantations after a median time of 40 days. Causes of liver disease were congenital biliary atresia (n=96), Alagille's syndrome (n=12), Byler's disease (n=8), and other cholestatic diseases (n=8).


RESULTS
Ninety (73%) patients received a split-liver graft, 28 (23%) a whole liver, and 6 (4%) a reduced-size liver. Overall 2- and 4-year patient survival rates were 93% and 91%, respectively; the 2- and 4-year graft-survival rates were 84% and 80%, respectively. In split-liver recipients, 4-year patient and graft-survival rates were 91% and 83%, respectively; these were 93% and 78%, respectively, in whole-liver recipients and 67% and 63%, respectively, in reduced-size liver recipients. Retransplantation rate was 11%, whereas mortality rate was 8%. Overall incidence of vascular and biliary complication were 16% and 27%, respectively.


CONCLUSIONS
SLT can provide liver grafts for children with ESCLD with an outcome similar to the one reported following LDLT, eliminating mortality while they are on a transplantation wait list. The need for pediatric LDLT should be reevaluated and programs of SLT strongly encouraged and supported at a national and international level.
Gridelli
Bruno
B
Department of General and Transplantation Surgery, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy.
Spada
Marco
M
Petz
Wanda
W
Bertani
Alessandro
A
Lucianetti
Alessandro
A
Colledan
Michele
M
Altobelli
Monica
M
Alberti
Daniele
D
Guizzetti
Michela
M
Riva
Silvia
S
Melzi
Maria L
ML
Stroppa
Paola
P
Torre
Giuliano
G
D000293:Adolescent; D000328:Adult; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000150:complications*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007223:Infant; D017093:Liver Failure / Q000209:etiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods*; D014184:Transplantation, Homologous