Outcomes in adult recipients of right-sided liver grafts in split-liver procedures.
BACKGROUND
The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial.


METHODS
From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV).


RESULTS
Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P= 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively.


CONCLUSIONS
Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.
Viganò
Luca
L
Department of Digestive and Hepatobiliary Surgery, Henri Mondor Hospital-University of Paris 12, Créteil, France.
Laurent
Alexis
A
Tayar
Claude
C
Merle
Jean-Claude
JC
Lauzet
Jean-Yves
JY
Hurtova
Monica
M
Decaens
Thomas
T
Duvoux
Christophe
C
Cherqui
Daniel
D
D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies