Use of extended right grafts from in situ split livers in adult liver transplantation: a comparison with whole-liver transplants.
BACKGROUND
We report our experience of in situ split-liver transplantation (SLT) for adult patients and compare the results with those achieved with whole-liver transplantation (WLT).


METHODS
From November 1997 to December 2003, 109 liver transplantation were performed in 104 adult patients including 90 WLT (83%) and 19 SLT (17%) grafts. Fifteen extended right grafts (ERG, segments I + IV to VIII) were obtained with in situ split-liver procedures, generating also left lateral segment grafts, which were transplanted at our institution or elsewhere. Four left lobe (LL, segments I to IV) and right lobe (segments V to VIII) grafts were obtained by a modified in situ procedure for adult recipients. UNOS status, percentage of primary or secondary transplantation, and underlying liver disease were similar among patients receiving whole versus split grafts. Donors were older in whole than ERG cohorts (53 vs 26 years, P < .001). Procurement parameters and intraoperative profiles of transplant procedure were comparable among the groups.


RESULTS
Median follow-up was 18 months (range: 1 to 73). Four patients with whole (4%) and no patient with ERG underwent retransplantation (P = NS). One- and 3-year patient survivals were 86% and 79% with WLT versus 93% and 93% with ERG (P = NS). One- and 3-year graft survivals were 84% and 75% with WLT versus 93%, and 93% with ERG (P = NS). Incidence of vascular complications was 8% with WLT, 13% with ERG (P = NS). The incidence of biliary complications was 13% in WLT, 27% in ERG (P = NS).


CONCLUSIONS
The use of ERG from in situ split livers for adult transplantation allowed us to obtain results comparable or even better than those obtained with WLT. Split-liver transplantation is an effective, safe mechanism to expand the cadaveric donor pool.
Spada
M
M
Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione-ISMETT, Palermo, Italy. mspada@ISMETT.edu
Cescon
M
M
Aluffi
A
A
Zambelli
M
M
Guizzetti
M
M
Lucianetti
A
A
Pinelli
D
D
Strazzabosco
M
M
Gridelli
B
B
Colledan
M
M
D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D015276:Health Care Rationing; D006439:Hemodynamics; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome