Liver Transpl 2000 Jul;6(4):415-28

Extensive use of split liver for pediatric liver transplantation: A single-center experience.

Spada M, Gridelli B, Colledan M, Segalin A, Lucianetti A, Petz W, Riva S, Torre
G

Liver Transplantation Center, Ospedali Riuniti di Bergamo, Bergamo, Italy.

Abstract
The results of the extensive use of in situ liver splitting in a pediatric liver
transplant program are presented. All referred donors were considered for split
liver, and when the donor-recipient body weight ratio (DRWR) was greater than 2,
the grafts were split. A modified split-liver technique was adopted when the
DRWR was 2 or less. Eighty liver procurements were attempted and 72 (90%) were
performed, enabling 65 children to receive 42 split, 22 whole, and 8
reduced-size livers. The right portions of the grafts were transplanted by other
centers into adults. Median patient waiting time was 22 days, with no mortality
on the waiting list. After a median follow-up of 14 months, overall patient and
graft survival rates were 85% and 81%, respectively. Fifty-eight children
received a single allograft, whereas 7 children required retransplantation.
Two-year actuarial survival rates were 85% for split-liver recipients, 84% for
whole-liver recipients, and 67% for reduced-size liver recipients. Vascular
complications developed in 18% of the patients, with no difference among the 3
groups with different technique. Biliary complications developed in 25% of the
children, mainly in reduced-size and split-liver recipients. Patient and graft
survival rates for right split-liver grafts were 84% and 79%, respectively.
Adopting a liberal policy of liver splitting provides allografts of optimal
quality for pediatric transplantation, allowing a dramatic decrease in the
waiting list time. The in situ split-liver technique should be considered the
method of choice for expanding the cadaveric liver donor pool.