Feasibility and limits of split liver transplantation from pediatric donors: an italian multicenter experience.
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.
Cescon
Matteo
M
Liver and Lung Transplantation Unit, Azienda Ospedaliera "Ospedali Riuniti", Bergamo, Italy.
Spada
Marco
M
Colledan
Michele
M
Torre
Giuliano
G
Andorno
Enzo
E
Valente
Umberto
U
Rossi
Giorgio
G
Reggiani
Paolo
P
Cillo
Umberto
U
Baccarani
Umberto
U
Grazi
Gian Luca
GL
Tisone
Giuseppe
G
Filipponi
Franco
F
Rossi
Massimo
M
Ettorre
Giuseppe Maria
GM
Salizzoni
Mauro
M
Cuomo
Oreste
O
De Feo
Tullia
T
Gridelli
Bruno
B
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