title: Split-liver transplantation using the left lateral segment: a collaborative sharing experience between two distant centers.
abstract: Split-liver transplantation (SLT) increases the pool of organs for pediatric orthotopic liver transplantation (pOLT). With increased collaboration and organ sharing, transplant centers can fully maximize the use of all split donor allografts. Herein, we report the collaborative results between two distant centers involved in a sharing alliance. The current study consists of a retrospective review of 56 pediatric LLS transplants performed at two collaborating centers between 9/1997 and 10/2003. Fifty-three patients (41% Status 1) were transplanted using 56 left lateral segment (LLS) grafts. Sixteen percent of LLS grafts were shared between the two institutions. Overall patient survival at both 1 and 3 years was 90% and 90%, respectively. Overall graft survival at both 1 and 3 years was 82% and 82%, respectively. Shared patient and graft survival was 89% and 89%, respectively. There was an 11% biliary complication and 18% vascular complication rate. Five patients required retransplantation. In conclusion, SLT increases the number of available allografts for pOLT. While SLT is technically demanding, with a significant learning curve, patient and graft survival rates compare favorably with United Network Organ Sharing (UNOS) averages. Sharing of grafts between centers is a safe and effective way to maximize organ usage and should be actively pursued through collaborative networks.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.forename: W Kenneth
authors.initials: WK
authors.lastname: Washburn
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Halff
authors.forename: Beth A
authors.initials: BA
authors.lastname: Carter
authors.forename: Saul J
authors.initials: SJ
authors.lastname: Karpen
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Bristow
authors.forename: Jaymee D
authors.initials: JD
authors.lastname: Scott
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003299:Cooperative Behavior; D005260:Female; D006085:Graft Survival; D015276:Health Care Rationing; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome