title: Feasibility and limits of split liver transplantation from pediatric donors: an italian multicenter experience.
abstract: OBJECTIVE
  To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.
  
  
  BACKGROUND
  There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended.
  
  
  METHODS
  From 1997 to 2004, 43 conventional split liver procedures from donors aged <15 years were performed. Nineteen donors weighing < or =40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults.
  
  
  RESULTS
  Two-year patient and graft survival rates were not significantly different between recipients of donors < or =40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the < or =40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively.
  
  
  CONCLUSIONS
  Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors < or =40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided.
authors.affiliation: Liver and Lung Transplantation Unit, Azienda Ospedaliera "Ospedali Riuniti", Bergamo, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Giuliano
authors.initials: G
authors.lastname: Torre
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rossi
authors.forename: Paolo
authors.initials: P
authors.lastname: Reggiani
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Ettorre
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Oreste
authors.initials: O
authors.lastname: Cuomo
authors.forename: Tullia
authors.initials: T
authors.lastname: De Feo
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome