title: [Need of hepatic bipartition or split in the transplant in children].
abstract: OBJECTIVE
  To analyze the benefits of Split (for adult and for child) in liver transplantation.
  
  
  METHODS
  1) Analysis of the waiting list mortality estimated on 228 inclusions for transplant since January 2004 to December 2008.2) Impact of the variant techniques (living-related donor and split) on the waiting list mortality in our patients. 3) Analysis of the outcome of 33 split livers which allowed to perform 66 transplants (1994-2008).
  
  
  RESULTS
  Estimated as number of patients by 1,000 candidates by year of exposure, the waiting list mortality was 110 in children older than 5 year old, 180 in children from 2 to 5 year-old, 90 in children between 1 and 2 year-old and 510 in younger than 1 year (p<0.05 for the last group). 36/66 split grafts were implanted by our group. Five grafts were lost, 3 due to retransplantation and 2 due to death. Overall patient/graft survival alter 10 years of follow-up was 94.5% and 85.1%, respectively. The rest of the grafts (n=30), were used in other hospitals, and 4 were lost in the early postoperative period. Since the beginning of the study, 85.4% of children between 1 and 2 years, received a living-donor or a split graft, as only 59.9% in the younger than 1 year-old group.
  
  
  CONCLUSIONS
  Our results absolutely justify the ethics of split liver transplantation for an adult and a child. Despite other factors, the benefits of the variant techniques in the 1-2 year-old group are obvious. Up to 60% optimization with these techniques in children younger than 1 year would not be yet enough in order to decrease the mortality waiting list down to that of the rest of the groups.
authors.affiliation: Departamento de Cirugía Pediátrica, Unidad de Trasplante Infantil, Hospital Universitario La Paz, Madrid. aneandresmo@hotmail.com
authors.forename: A M
authors.initials: AM
authors.lastname: Andrés
authors.forename: M
authors.initials: M
authors.lastname: López Santamaría
authors.forename: L
authors.initials: L
authors.lastname: Burgos
authors.forename: F
authors.initials: F
authors.lastname: Herńandez
authors.forename: J L
authors.initials: JL
authors.lastname: Encinas
authors.forename: S
authors.initials: S
authors.lastname: Barrena
authors.forename: M
authors.initials: M
authors.lastname: Miguel
authors.forename: N
authors.initials: N
authors.lastname: Leal
authors.forename: L
authors.initials: L
authors.lastname: Martínez
authors.forename: M
authors.initials: M
authors.lastname: Gámez
authors.forename: J
authors.initials: J
authors.lastname: Murcia
authors.forename: E
authors.initials: E
authors.lastname: Frauca
authors.forename: P
authors.initials: P
authors.lastname: Jara
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D000328:Adult; D002675:Child, Preschool; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*