title: Starting a new program of split liver transplantation after a low learning curve: a reality in centers with large experience in liver surgery and whole liver transplantation.
abstract: OBJECTIVE
  Split liver transplantation (SLT) is nowadays, considered an adequate surgical solution to expand the grafts from the existing pool of cadaveric donors.
  
  
  METHODS
  A total of 897 liver transplantations were performed between 1986 and 2002; 20 were SLTs (2.3%). A 30% were children.
  
  
  RESULTS
  Mean follow up of 15.15 months +/- 13.85. Median age was 42.27 +/- 25.65 yrs. Median recipient weight was 52.29 +/- 20.87 Kg. Mean donor weight was 76.1 +/- 13.11. The majority was "in situ" SLT (65%). There was no primary graft dysfunction. Two patients developed biliary complications (none in situ SLT). Early HAT occurred in 2 patients and delayed HAT in one. Four patients were retransplanted but none were performed because of primary graft dysfunction. Five patients died in the hospital. Fifteen patients (75%) survived the postoperative period and 3 patients died during follow-up. Mean patient survival time was 42 months (95% CI: 31-52). Actuarial patient survival was 93.3%, 84.4%, 84.4% at 6 months, 1 year and 3 years. Mean graft survival was 36 months (95% CI: 25-48). Actuarial graft survival was 87%, 72%, 72% at 6, 12, 36 months. Univariate analysis of risk factors for graft loss showed that the type of splitting technique (p=0.019), and the UNOS (1 and 2a) status of the recipient (p=0.001) were significantly associated with graft loss.
  
  
  CONCLUSIONS
  In the context of large volume full cadaveric liver transplantation, split liver can provide adequate results (even after a short learning curve) mainly in elective cases and with the in situ technique.
authors.affiliation: Deparment of General, Digestive and Abdominal Organs Transplation, University Hospital 12 de Octubre, Madrid, Spain. jcmeneu@hotmail.com
authors.forename: J C
authors.initials: JC
authors.lastname: Meneu-Diaz
authors.forename: E
authors.initials: E
authors.lastname: Moreno-Gonzalez
authors.forename: I
authors.initials: I
authors.lastname: Garcia
authors.forename: A
authors.initials: A
authors.lastname: Moreno-Elola
authors.forename: B
authors.initials: B
authors.lastname: Perez Saborido
authors.forename: Y
authors.initials: Y
authors.lastname: Fundora Suarez
authors.forename: S
authors.initials: S
authors.lastname: Jimenez-Galanes
authors.forename: S
authors.initials: S
authors.lastname: Olivares
authors.forename: M
authors.initials: M
authors.lastname: Hidalgo Pascual
authors.forename: M
authors.initials: M
authors.lastname: Abradelo
authors.forename: C
authors.initials: C
authors.lastname: Jimenez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012307:Risk Factors