title: Improving graft survival by understanding the mechanism of segment 4 complications after split liver transplantation.
abstract: This study was designed to assess the actual mechanism of segment 4 (S4)-related complications after split liver transplantation (SLT) and their impact on graft and overall survival with reference to those of left lateral sectionectomy for pediatric living donor liver transplantation (LLSLD).
  
  
  
  Clinical data from 53 SLT recipients and 62 LLSLD patients were assessed to determine the mechanism of S4-related complications. The postoperative parameters of SLT and their impact on graft and overall survival were also evaluated.
  
  
  
  Although two biliary leakages were noted (3.2%), no necrosis of S4 developed after LLSLD. S4-related complications were seen in 15 (28.3%) patients after SLT. Radiological volumetry of S4 and the ischemic area after SLT showed no significant difference between those with and without S4-related complications. There were no significant differences between the patients with and without S4-related complications regarding both overall and graft survival rates. Significant better overall and graft survival rates were observed in patients treated during the later period.
  
  
  
  S4-related complications after SLT are totally independent of the S4 volume, and biliary leakage is inherently an actual mechanism. Adequate intervention with early identification leads to better graft and overall survival, which validates SLT as a treatment option.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Shohei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Fernando Pompeu Piza
authors.initials: FP
authors.lastname: Vicentine
authors.affiliation: Department of Radiology, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Sanaâ
authors.initials: S
authors.lastname: El Mouhadi
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Brustia
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Perdigao
authors.affiliation: Department of Hepatobiliary and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, France.|Université Paris VII, Paris, France.
authors.forename: Ailton
authors.initials: A
authors.lastname: Sepulveda
authors.affiliation: Department of Hepatobiliary and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, France.|Université Paris VII, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. olivier.scatton@psl.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: biliary leakage; living donor liver transplantation; necrosis; segment 4; split liver transplantation