Split liver transplantation: a single center experience

Background: Split liver transplantation is used worldwide and allows for an increase of donor organ pool, especially for pediatric recipients. Donor selection, some aspects of surgical techniques and long-term results remain to be important issues of split liver transplantation.Aim: To analyze our own clinical results of split liver transplantation, basic principles of deceased donor selection and specifics of surgical technique.Materials and methods: From May 2008 to December 2019, 32 cases of division of the deceased donor liver for transplantation to two recipients have been performed (64 split liver transplantations). Liver was divided into the left lateral section and the extended right lobe in 30 cases (“classical split”), and into the left lobe and right lobe in two cases (“full-split”). In 22 cases, the liver grafts were split in situ and in 10, ex-situ.Results: In the recipients of left-side transplants (left lateral section and whole left lobe), the one-, three-, and five-year survival rates were 80, 80, and 60%, respectively. In the right-sided transplant recipients (extended right lobe and right lobe), the one-, three-, and five-year survival rates were 93.3, 89.4, and 89.4%, respectively (p = 0.167). The most probable risk factors for mortality in the univariate analysis were liver retransplantation (p = 0.047) and patient’s weight (p = 0.04).Conclusion: For split transplantation, it is advisable to consider donors with a high-quality liver. This technique demonstrates satisfactory results and can be viewed as effective for patients with terminal liver diseases.

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Full-split liver transplantation. The first experience in Russian Federation

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021166-75 ◽

2021 ◽

Vol 26 (1) ◽

pp. 66-75

Author(s):

S. E. Voskanyan ◽

I. Yu. Kolyshev ◽

M. V. Shabalin ◽

A. I. Artemyev ◽

V. S. Rudakov ◽

...

Keyword(s):

Liver Transplantation ◽

Deceased Donor ◽

Treatment Method ◽

Ex Situ ◽

Biliary Leak ◽

Team Members ◽

Split Liver Transplantation ◽

Split Liver ◽

Points Of View ◽

End Stage

Aim. To present the first successful full-split liver transplantation for two adults recipients in Russia.Materials and methods. The first successful full-split liver transplantation for two adults in ex situ way in Russia was made on 26th of September 2014 in the Burnasyan Federal Medical Biophysical Center of FMBA. The deceased donor was inside UNOS, Lee. The GRWR index in both recipients was near 1. The first recipient had been in a waiting list for 1 year, the second for 4 months. Both recipients had got liver cirrhosis in terminal stage.Results. The surgical procedure length was 650 and 660 min. The overall time of cold ischemia was 510 min. We observed a primary function of each graft. ISGLS B and Clavien-Dindo 3A biliary leak complications were observed in both recipients. Both patients were discharged after 33 and 34 days. Overall survival for this moment is 68 months.Conclusion. Full-split liver transplantation for two adults in ex situ way seems to be a complicated procedure both from the technical and organizing points of view. It demanding good mastership and coordination between surgical team members. At the same time, that treatment method has to be spread widely to improve treatment of patients with end-stage cirrhosis results.

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Split liver transplantation in two recipients for urgent indications: an example and logistics of interregional cooperation

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2020471-84 ◽

2020 ◽

Vol 25 (4) ◽

pp. 71-84

Author(s):

I. A. Porshennikov ◽

A. A. Ammosov ◽

A. B. Sidorenko ◽

V. N. Pavlik ◽

A. Yu. Bykov ◽

...

Keyword(s):

Liver Transplantation ◽

Left Lobe ◽

Biliary Leakage ◽

Split Liver Transplantation ◽

Endovascular Interventions ◽

Artery Thrombosis ◽

Arterial Bleeding ◽

Split Liver ◽

Right Lobe ◽

The Right

Aim. To report a rare case of split liver transplantation in two urgent recipients treated in hospitals that are very far from each other. Material and methods. Partial liver grafts were obtained by controlled full-right/full-left in situ splitting. The left lobe was transplanted in a 7-year-old child with severe hepatic failure (PELD score 39) resulting, probably from an progressive intrahepatic familial cholestasis in Novosibirsk. The right lobe was used for re-transplantation in a 28-year-old patient with hepatic artery thrombosis (UNOS status 1A) after living donor right lobe liver transplantation in Moscow. Results. The course of the early post-operative period in recipient 1 was complicated by infected total pancreatonecrosis with the development of limited biliary leakage and the formation of a stricture, which required reconstructive cholangiojejunostomy 12 months after transplantation. Recipient 2 consistently underwent biliary leakage, arrosive arterial bleeding, graft artery thrombosis, all of which could become fatal. Complications were successfully eliminated by the consistent use of surgical and endovascular interventions. Conclusion. The presented observation is, firstly, an example of effective inter-center cooperation, and secondly, a demonstration of the existing problems of postmortem organ donation, which determine the need for such extreme surgery in critical situations.

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Surgical Aspects of Split Liver Transplantation: а Review

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2019-29-3-7-17 ◽

2019 ◽

Vol 29 (3) ◽

pp. 7-17

Author(s):

S. V. Gautier ◽

R. A. Latypov ◽

A. R. Monakhov

Keyword(s):

Liver Transplantation ◽

Graft Loss ◽

Surgical Techniques ◽

Weight Ratio ◽

Deceased Donor ◽

Ex Situ ◽

Split Liver Transplantation ◽

Split Liver ◽

Key Aspects ◽

Surgical Aspects

Aim. To analyse the surgical aspects of performing a split liver transplantation in patients with end-stage liver disease.Key findings. Split liver transplantation (SLT) is a technique allowing two functional grafts to be obtained from one deceased donor to simultaneously save the lives of two recipients. The global clinical experience of SLT application currently comprises more than three decades. Criteria necessary for successful SLT were developed, based both on assessment of graft quality (age and anthropometric characteristics of the donor, laboratory parameters, ultrasound data, length of stay in intensive care, as well as macroscopic intraoperative assessment of the liver), and on the selection of recipients (primarily in accordance with the height-weight characteristics and the use of the GRWR [graftto-recipient weight ratio]). The use of these criteria allows the results to be achieved comparable to other types of liver transplantation (a whole liver from a deceased donor or liver fragments of an intravital donor). However, issues involved with of the optimal choice of surgical techniques remain to be solved, which include such key aspects as the anatomical method of separation (left lateral section and extended right lobe; anatomical left and right lobes of the liver), an optimal method of separation (ex situ or in situ) and others. The issues of logistics of the SLT application, including the principles of allocation of transplants, also remain significant. Ethical aspects are equally important, since, theoretically, the widespread introduction of the SLT technique may increase the risk of graft loss. The immediate and long-term SLT results require further study, which makes it possible to form a more objective opinion on the effectiveness of the technique.Conclusion. SLT shows good results both in the near and in the remote period. The key aspects of SLT performing are a deep understanding of the variant anatomy of the liver and a high level of knowledge of liver resection surgery. The active use of SLT allows the pool of donor organs to be increased, which is of great importance under the conditions of their permanent lack.

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