Split liver transplantation in adults.
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues.
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Koji
K
Hashimoto
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Masato
M
Fujiki
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Cristiano
C
Quintini
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Federico N
FN
Aucejo
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Teresa Diago
TD
Uso
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Dympna M
DM
Kelly
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Bijan
B
Eghtesad
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
John J
JJ
Fung
Koji Hashimoto, Masato Fujiki, Cristiano Quintini, Federico N Aucejo, Teresa Diago Uso, Dympna M Kelly, Bijan Eghtesad, John J Fung, Charles M Miller, Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
Charles M
CM
Miller
D000328:Adult; D002648:Child; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000941:ethics / Q000379:methods*; D009929:Organ Size; D018579:Patient Selection; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
Adults; Donor and recipient selection; Ethical issues; Graft size; Graft survival; Split liver transplantation; Surgical technique
Transplantation. 2008 Nov 27;86(10):1468-9
19034019
Am J Transplant. 2001 Nov;1(4):366-72
12099382
Am J Transplant. 2015 Jan;15(1):17-38
25358749
Ann Surg. 2013 Aug;258(2):306-11
23108123
Liver Transpl. 2015 Apr;21(4):500-11
25545700
Transplant Proc. 2011 Jul-Aug;43(6):2391-3
21839274
Transpl Int. 2006 Jun;19(6):492-9
16771871
Transpl Int. 2009 Jul;22(7):702-6
19254241
Transpl Int. 2008 Mar;21(3):218-22
17850237
Am J Surg Pathol. 2006 Aug;30(8):986-93
16861970
Liver Transpl. 2009 Dec;15(12):1776-82
19938139
Am J Transplant. 2004 Nov;4(11):1737-40
15476469
Am J Transplant. 2008 Dec;8(12):2569-79
18976306
Liver Transpl Surg. 1999 Sep;5(5):366-8
10477836
Br Med Bull. 2010;94:33-48
20144939
Am J Transplant. 2012 Aug;12(8):2198-210
22578214
Ann Surg. 1999 Mar;229(3):313-21
10077042
Br J Surg. 2012 Jun;99(6):839-47
22511247
Ann Surg. 1990 Jul;212(1):14-22
2363599
Am J Transplant. 2014 Sep;14(9):2072-80
25040819
Ann Surg. 2014 Jan;259(1):157-65
23422004
Ann Surg. 1990 Sep;212(3):368-75; discussion 375-7
2396888
Lancet. 2002 Feb 2;359(9304):406-7
11844516
Surgery. 1984 Mar;95(3):367-70
6367125
Surgery. 2010 Sep;148(3):582-8
20227098
Am J Transplant. 2006 Apr;6(4):783-90
16539636
Ann Surg. 2005 Dec;242(6):802-12, discussion 812-3
16327490
Liver Transpl. 2008 Mar;14 (3):374-9
18306381
HPB (Oxford). 2009 Jun;11(4):296-305
19718356
Langenbecks Arch Chir. 1988;373(2):127-30
3287073
Transplant Proc. 2011 Apr;43(3):884-7
21486620
Hepatology. 1995 May;21(5):1317-21
7737637
Br J Surg. 1989 Jul;76(7):722-4
2670054
Transplantation. 1999 Feb 15;67(3):343-8
10030276