Conventional split liver transplantation for two adult recipients: a recent experience in a single European center.
BACKGROUND
Split liver transplantation (SLT) for two adult recipients is still considered a challenging procedure, especially when subjected to model for end-stage liver disease (MELD)-based allocation criteria.


METHODS
Twenty-two SLTs were performed in adult recipients in a European center operating within a MELD-oriented system. Thirteen right-sided grafts and nine left-sided grafts were used. Right-sided grafts included 11 extended right grafts and two full right grafts. Left-sided grafts included six left lateral segment grafts and three full left grafts. Ninety-three percent of donors were allocated based on MELD score. Median graft-to-recipient body weight ratio was 1.53 (range 1.07-2.11) with right-sided grafts and 0.81 (range 0.67-1.11) with left-sided grafts. Liver cirrhosis (46%) and metabolic/genetic disorders (56%) were the main indications for transplant in recipients of right and left grafts, respectively.


RESULTS
Overall patient and graft survival were 90% and 86%. Patient survival was 84% in recipients of right grafts and 100% in recipients of left grafts. Graft survival was 84% and 89%, respectively. Vascular and biliary complications occurred in 14% and 4% of cases. Postoperative serum levels of total bilirubin were significantly higher in recipients of left-sided grafts versus right-sided grafts on postoperative days 7 and 14. Prothrombin activity was significantly lower in recipients of left-sided grafts versus right-sided grafts on postoperative days 3 and 7.


CONCLUSIONS
SLT for two adult recipients can be successfully performed even using left lateral segments by assigning one graft according to MELD score, and with a more liberal allocation of the second graft.
Cescon
Matteo
M
General Surgery and Transplant Unit, Department of General Surgery and Transplantation, University of Bologna, Bologna, Italy. matteo.cescon@aosp.bo.it
Grazi
Gian Luca
GL
Ravaioli
Matteo
M
Ercolani
Giorgio
G
Del Gaudio
Massimo
M
Vivarelli
Marco
M
Cucchetti
Alessandro
A
Zanello
Matteo
M
Vetrone
Gaetano
G
Lauro
Augusto
A
Pinna
Antonio Daniele
AD
D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D005500:Follow-Up Studies; D007839:Functional Laterality; D006085:Graft Survival / Q000502:physiology*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011517:Prothrombin Time; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D001663:Bilirubin