Split-liver transplantation: a review.

Split-liver transplantation (SLT), a procedure where one cadaver liver is divided to provide for two recipients, offers immediate expansion of the existing cadaver donor pool. To date, the principal beneficiaries of SLT have been adult/pediatric recipient pairs with excellent outcomes reported; however, the current scarcity of cadaver organs has renewed interest in expanding these techniques to include two adult recipients from one adult cadaver donor. Significant obstacles to the widespread application of SLT exist and must be resolved by the transplant community before greater utilization can be realized. This manuscript reviews the historic background, surgical techniques, current results, and obstacles impeding further application of SLT.

One hundred in situ split-liver transplantations: a single-center experience.

OBJECTIVE: To identify predictors of graft and recipient survival from a single-institution series of in situ split-liver transplantations and compare outcomes to living donor and whole organs for adults and children. SUMMARY BACKGROUND DATA: Split-liver transplantation is a surgical technique that creates 2 allografts from a single cadaver donor. We have applied split-liver transplantation to all indications and categories of medical urgency for initial as well as retransplantation to expand the current donor pool and decrease reliance upon living donation. METHODS: A retrospective analysis was conducted of 100 consecutive in situ split-liver transplantations yielding a left lateral segment and right trisegment graft that were performed at the University of California Los Angeles between 9/91 and 02/03. These 100 transplantations generated 190 allografts for transplantation into 105 children and 60 adults, with the sharing of 25 allografts among transplant centers across the United States. Outcomes and incidence of complications were compared with living donor and whole organ recipients receiving liver transplantation during the same time period with independent predictors of split-liver graft and recipient survival identified by multivariate analysis. RESULTS: The incidence of biliary and vascular complications observed in recipients of left lateral segment grafts created by split-liver transplantation was not statistically different from recipients of left lateral segment grafts created from living donation or children receiving whole-organ grafts from pediatric donors. Kaplan-Meier survival estimations of left lateral segment graft and recipient survival also demonstrated no statistical difference among split-liver, living donor, and whole-organ recipients. Right trisegment grafts from split-liver transplantation demonstrated a 10% incidence of biliary and 7% incidence of vascular complications. Long-term graft function was excellent with patient and graft survival equal to 1086 recipients of cadaver whole-organ grafts from donors ages 10-40 years who underwent transplant operations during the same time period. Predictors of split-liver transplantation graft and recipient survival included United Network for Organ Sharing status at transplantation, indication, occurrence of a complication, donor creatinine, and donor length of hospitalization. CONCLUSIONS: Split-liver transplantation is an effective mechanism for immediate expansion of the cadaver donor pool that can reduce dependence upon living donation in adults and children.

The conventional technique in in-situ split-liver transplantation.

Split-liver transplantation are innovative surgical techniques of graft creation that expand the cadaver donor pool and decrease reliance upon living-donation. To date, split-liver transplantation has been principally applied to pediatric recipients with excellent outcomes. Significant decreases in pediatric wait-list times, wait-list morbidity, and lower utilization of living-donation at centers that routinely implement split-liver transplantation have led to renewed interest in expanding these techniques to include two adult recipients from one adult cadaver donor. This article details technical considerations of the conventional in situ split procedure for the creation of a pediatric left lateral segment graft and an adult trisegment graft, and summarizes current outcomes.

Multivisceral and isolated intestinal procurement techniques.

Improved outcomes in multivisceral and isolated intestinal transplantation have generated increased demand for these procedures. Enhanced recognition of potential multivisceral/intestinal donors and widespread application of advanced organ procurement techniques is necessary in the current climate of organ scarcity. This manuscript details the multivisceral and isolated intestinal procurement techniques currently performed at the University of California Los Angeles.

Changing faces of liver transplantation: partial-liver grafts for adults.

The utilization of partial-liver grafts for transplantation of adults represents an evolution from strategies designed to increase pediatric organ supply that have been justified by increased organ-waiting times and morbidity of adult transplant candidates. These techniques, which include adult-to-adult living-donor and split-liver transplantation, mandate particular surgical and medical considerations, as partial-liver grafts predispose to unique complications resulting from anatomic variations, technical considerations, and recipient physiology. Adult-to-adult living-donor liver transplantation has been successfully reported throughout the world; however, the magnitude of the donor operation has resulted in serious morbidity and donor mortality that have stimulated an ethical debate as to the future of this procedure. The limitations encountered in the application of adult-to-adult, living-donor liver transplantation have renewed interest in the successful implementation of split-liver transplantation between two adults from one adult cadaver donor. This manuscript details current technical considerations for the performance of adult-to-adult living-donor and split-liver transplantation, summarizes current outcomes, and explores the ethical dilemma of living-donation.

Acquired hemophilia A after liver transplantation: a case report.

It is well recognized that orthotopic liver transplantation rapidly corrects the coagulation disorder observed in patients with hemophilia A or B combined with end-stage liver disease; however, the transmission of hemophilia from a donor to a transplant recipient has not been reported previously. We describe a patient who developed acquired hemophilia A after liver transplantation due to the unknown presence of factor VIII inhibitor in the donor. The resulting coagulation disorder was unresponsive to standard factor replacement therapy, and was ultimately corrected with retransplantation. Hemophiliac donors should not be precluded from organ donation, though the presence of factor VIII inhibitor should be actively sought before organ procurement. High levels of factor VIII inhibitor represents an absolute contraindication to liver donation.