Should we still offer split-liver transplantation for two adult recipients? A retrospective study of our experience
✍ Scribed by Alessandro Giacomoni; Andrea Lauterio; Matteo Donadon; Andrea De Gasperi; Luca Belli; Abdallah Slim; Bogdan Dorobantu; Iacopo Mangoni; Luciano De Carlis
- Publisher
- John Wiley and Sons
- Year
- 2008
- Tongue
- English
- Weight
- 139 KB
- Volume
- 14
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.21466
No coin nor oath required. For personal study only.
✦ Synopsis
The role of split-liver transplantation (SLT) for two adult recipients is still a matter of debate, and no agreement exists on indications, surgical techniques, and results. The aim of this study was to retrospectively analyze the outcome of our series of SLT. From May 1999 to December 2006, 16 patients underwent SLT at our unit. We used 9 full right grafts (segments 5-8) and 7 full left grafts (segments 1-4). The splitting procedure was always carried out in situ with a fully perfused liver. Postoperative complications were recorded in 8 (50%) patients: 5 (55%) in full right grafts and 3 (43%) in full left grafts. No one was retransplanted. After a median follow-up of 55.82 months (range, 0.4-91.2), 5 (31%) patients died, and the 1-, 3-, and 5-year overall survival rate for patients and grafts was 69%. We considered as a control group for the global outcome 232 whole liver transplantations performed at our unit in the same period of time. Postoperative complications were recorded in 53 (23%) patients, and after a median follow-up of 57.37 months (mean, 55.11; range, 1-102.83), the 1-, 3-, and 5-year overall patient survival was 87%, 82%, and 80%, respectively. In conclusion, SLT for two adult recipients is a technically demanding procedure that requires complex logistics and surgical teams experienced in both liver resection and transplantation. Although the reported rate of survival might be adequate for such a procedure, more efforts have to be made to improve the short-term outcome, which is inadequate in our opinion. The true feasibility of SLT for two adults has to be considered as still under investigation.