title: In situ split liver transplantation for adult and pediatric recipients: an answer to organ shortage.
abstract: BACKGROUND
  We report our initial experience with in situ split liver transplantation (SLT) for adult and pediatric patients.
  
  
  METHODS
  From June 2003 to August 2005, 177 liver transplantations in 165 patients, 133 adults (81%) and 32 children (19%), were performed at our institution. Over this period, 45 liver transplantations (25%) were performed with an in situ split liver technique in 44 patients: 17 (39%) were adults and 27 (61%) children. All of the adult split liver recipients were transplanted with an extended right graft (ERG; segments I + IV-VIII), while pediatric recipients received in 23 cases a left lateral segment (LLS; segments II-III) and in 4 cases an ERG from a pediatric donor. The 45 split liver grafts (21 ERGs and 24 LLSs) were generated from 35 donors. In 10 cases we used both grafts generated with an in situ split procedure to transplant our patients, while in 25 cases the procurement procedure was performed in collaboration with other transplant centers.
  
  
  RESULTS
  After a median follow-up of 9 months (range, 1-27 months), the overall patient survival rate was 88% for adult patients and 82% for pediatric patients. Graft survivals were 88% and 79%, respectively. Two adult patients (12%) died from sepsis in the early postoperative period. Five children (18%) died after their transplantations. Only one pediatric recipient (2%) of primary SLT underwent retransplantation. Vascular complications were absent in adult recipients, whereas 4 arterial (14%) and 4 venous (14%) complications developed in the pediatric population. The incidence of biliary complications was 23% in adult and 18% in pediatric recipients.
  
  
  CONCLUSIONS
  The use of in situ SLT for adult and pediatric populations allowed us to expand the cadaveric donor pool, significantly eliminating pediatric waiting list mortality without penalizing the adult population.
authors.affiliation: Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT), University of Pittsburgh Medical Center, Palermo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Cintorino
authors.forename: M
authors.initials: M
authors.lastname: Spada
authors.forename: S
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: S
authors.initials: S
authors.lastname: Riva
authors.forename: A
authors.initials: A
authors.lastname: Luca
authors.forename: R
authors.initials: R
authors.lastname: Volpes
authors.forename: G
authors.initials: G
authors.lastname: Vizzini
authors.forename: A
authors.initials: A
authors.lastname: Arcadipane
authors.forename: K
authors.initials: K
authors.lastname: Henderson
authors.forename: R
authors.initials: R
authors.lastname: Verzaro
authors.forename: C Scotti
authors.initials: CS
authors.lastname: Foglieni
authors.forename: B
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000328:Adult; D002648:Child; D005500:Follow-Up Studies; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*