Transplantation 1997 Sep 27;64(6):871-7

In situ splitting of the cadaveric liver for transplantation.

Goss JA, Yersiz H, Shackleton CR, Seu P, Smith CV, Markowitz JS, Farmer DG,
Ghobrial RM, Markmann JF, Arnaout WS, Imagawa DK, Colquhoun SD, Fraiman MH,
McDiarmid SV, Busuttil RW

Department of Surgery, University of California at Los Angeles, USA.

Abstract

BACKGROUND: The shortage of cadaveric donor livers is the rate-limiting step in
clinical liver transplantation. Split liver transplantation provides a means to
expand the cadaveric donor pool. However, this concept has not reached its full
potential because of inferior patient and graft survival and high complication
rates when traditional ex vivo split techniques are used. Therefore we sought to
evaluate the safety, applicability, and effectiveness of a new technique for
split liver transplantation. METHODS: This study consists of 15 in situ split
liver procurements, which resulted in 28 liver transplants. In situ splitting of
selected livers from hemodynamically stable cadaveric donors was performed at
the donor hospital without any additional work-up or equipment being needed. In
situ liver splitting is accomplished in a manner identical to the living-donor
procurement. This technique for liver splitting results in a left lateral
segment graft (segments 2 and 3) and a right trisegmental graft (segments 1 and
4-8). This procedure required the use of the donor hospital operating room for
an additional 1.5-2.5 hr and did not interfere with the procurement of 30
kidneys, 12 hearts, 7 lungs, and 9 pancreata from these same donors. RESULTS:
The 6-month and 1-year actuarial patient survival rates were 92% and 92%,
respectively, while the 6-month and 1-year actuarial graft survival rates were
86% and 86%, respectively. The 6-month and 1-year actuarial patient survival
rate of patients who received a left lateral segment graft was 100% and 100%,
respectively, while those who received a right trisegmental graft had 6-month
and 1-year rates of 86% and 86%, respectively. The actuarial death-censored
graft survival rates at 6 months and 1 year were 80% and 80%, respectively, for
the left lateral segment grafts, and 93% and 93%, respectively, for the right
trisegmental grafts. Alograft and patient survival was independent of United
Network for Organ Sharing status at the time of liver transplantation. No
patient developed a biliary stricture, required re-exploration for
intra-abdominal hemorrhage, or suffered from portal vein, hepatic vein, or
hepatic artery thrombosis CONCLUSIONS: In situ split liver transplantation can
be accomplished without complications and provides results that are superior to
those obtained previously with ex vivo methods. It abolishes ex vivo benching
and prolonged ischemia times and provides two optimal grafts with hemostasis
accomplished. This technique decreases pediatric waiting time and allows adult
recipients to receive right-sided grafts safely. In situ splitting is the method
of choice for expanding the cadaveric liver donor pool.