title: Outcomes in adult recipients of right-sided liver grafts in split-liver procedures.
abstract: 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.
authors.affiliation: Department of Digestive and Hepatobiliary Surgery, Henri Mondor Hospital-University of Paris 12, Créteil, France.
authors.forename: Luca
authors.initials: L
authors.lastname: Viganò
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Claude
authors.initials: C
authors.lastname: Tayar
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Merle
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lauzet
authors.forename: Monica
authors.initials: M
authors.lastname: Hurtova
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
mesh_terms: 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