title: Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease.
abstract: 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.
authors.affiliation: Department of General and Transplantation Surgery, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Wanda
authors.initials: W
authors.lastname: Petz
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bertani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lucianetti
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Monica
authors.initials: M
authors.lastname: Altobelli
authors.forename: Daniele
authors.initials: D
authors.lastname: Alberti
authors.forename: Michela
authors.initials: M
authors.lastname: Guizzetti
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.forename: Maria L
authors.initials: ML
authors.lastname: Melzi
authors.forename: Paola
authors.initials: P
authors.lastname: Stroppa
authors.forename: Giuliano
authors.initials: G
authors.lastname: Torre
mesh_terms: 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