Split-liver transplantation: results of statewide usage of the right trisegmental graft.
Split-liver transplantation (SLT) effectively expands the cadaveric donor pool for children. The remaining right trisegmental (RTS) graft can be transplanted into adults. Limited information exists regarding the outcomes of RTS allografts. Sixty-five RTS graft recipients from five adult transplant programs in Texas were identified. Donor and recipient information were analyzed retrospectively. Most livers (75%) were originally allocated to pediatric recipients. Liver splitting occurred via the in situ (72%) and ex situ (28%) techniques. Arterial reconstruction of RTS grafts was common (52%). Patient and graft survival at 3 months were comparable for the in situ and ex situ techniques (p = 0.2). Cox regression showed only in situ splitting to be a predictor of outcome longer than 3 months posttransplant. Sharing of grafts between centers was frequent (37% of total). One-year patient and allograft survival (87.1% and 85.4%) were excellent with no cases of primary nonfunction. SLT consistently generates two functional liver allografts with excellent recipient survival. In situ splitting of the liver is the preferred technique. Decreased survival is observed with RTS graft use in higher risk recipients. Broader application of SLT with increased sharing is feasible and safely expands the number of liver allografts that can be transplanted.
Washburn
Kenneth
K
The Transplant Center, The University of Texas Health Science Center, San Antonio, TX, USA.
Halff
Glenn
G
Mieles
Luis
L
Goldstein
Robert
R
Goss
John A
JA
D000328:Adult; D015331:Cohort Studies; D015925:Cryopreservation; D005260:Female; D006085:Graft Survival; D015276:Health Care Rationing; D006801:Humans; D008099:Liver; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D012189:Retrospective Studies; D016019:Survival Analysis; D013781:Texas; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*