Ann Surg 1990 Jul;212(1):14-22

Transplantation of two patients with one liver. Analysis of a preliminary
experience with 'split-liver' grafting

Emond JC, Whitington PF, Thistlethwaite JR, Cherqui D, Alonso EA, Woodle IS,
Vogelbach P, Busse-Henry SM, Zucker AR, Broelsch CE

Department of Surgery, University of Chicago Pritzker Medical School, Wyler
Children's Hospital, Illinois

Abstract

Surgical reduction of donor livers to treat small children has been performed
successfully in several centers. While this procedure improves the allocation of
livers, it does not increase the organ supply. We have extended reduced-size
orthotopic liver transplantation (OLT) to treat 18 patients with 9 livers,
accounting for 26% of our transplants during a 10-month period and have
evaluated the results. In 18 split liver OLTs, patient survival was 67% and
graft survival was 50%. In comparison, for 34 patients treated with full-size
OLT during the same period, patient survival was 84% (p = 0.298) and graft
survival was 76% (p = 0.126). Biliary complications were significantly more
frequent in split grafts, occurring in 27%, as compared to 4% in full-sized
grafts (p = 0.017). Primary nonfunction (4% versus 5.5%) and arterial thrombosis
(6% versus 9%) occurred with similar frequency in split and full-size OLT (p =
not significant). These results demonstrated that split-liver OLT is feasible
and could have a substantial impact in transplant practice. We believe that
biliary complications can be prevented by technical improvements and that
split-liver OLT will improve transplant therapy by making more livers available