title: Adult left liver transplantation from split livers and living donors: a 14-year single-center experience.
abstract: BACKGROUND
  In an era of organ scarcity, the use of left liver grafts for adult recipients could increase the access to liver transplantation (LT). The aim of this study was to evaluate the results in a single-center series of adult left LT over a 14-yr period.
  
  
  METHODS
  Between March 1996 and March 2010, 30 adult patients underwent LT with a left liver obtained from 16 split cadaveric livers and 14 living donors (LD). Portal vein inflow modulation was performed in selected cases.
  
  
  RESULTS
  A total of 19 (63.3%) grafts had early dysfunction leading to graft failure in six cases (20%). One third of the grafts developed small-for-size syndrome (SFSS). One-yr patient and graft survival was 80% and 76.7%, respectively. Regarding two successive periods, one-yr patient and graft survival dramatically increased from 62.5% to 100% (p = 0.01) and 56.2% to 100% (p = 0.002), respectively. Multivariate analysis disclosed that completion of a portosystemic shunt and the occurrence of post-operative ascites were significantly associated with graft failure.
  
  
  CONCLUSIONS
  Our results support that improved surgical techniques and careful patient selection can lead to a safe use of left livers for transplantation in adult recipients. Inflow modulation could be performed in very selected cases.
authors.affiliation: Liver Transplant Unit, Department of Hepatobiliary-Pancreatic Surgery and Hepatology, Lyon, France. olivier.boillot@chu-lyon.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Pierre
authors.initials: P
authors.lastname: Sagnard
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Charles-Eric
authors.initials: CE
authors.lastname: Ber
authors.forename: Michel
authors.initials: M
authors.lastname: Pouyet
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
keywords: graft survival; patient survival; portal vein inflow modulation; small-for-size grafts; small-for-size syndrome