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. 1998 Feb;227(2):282–288. doi: 10.1097/00000658-199802000-00019

Split liver transplantation: King's College Hospital experience.

M Rela 1, V Vougas 1, P Muiesan 1, H Vilca-Melendez 1, V Smyrniotis 1, P Gibbs 1, J Karani 1, R Williams 1, N Heaton 1
PMCID: PMC1191247  PMID: 9488528

Abstract

BACKGROUND: The purpose of split liver transplantation is to increase the source of pediatric grafts without compromising the adult donor pool. Early results have been discouraging because of technical complications and selection of poor risk patients. METHODS: The results of a single center experience of 41 split liver transplantations were analyzed. Patient and graft survival and complications related to the technique were analyzed. RESULTS: Patient and graft survival for the whole group was 90% and 88% respectively at a median follow up of 12 months (range 6-70 months). Patient and graft survival for the right lobe graft was 95% and the left lateral segment 86% and 82% respectively. Four patients died, of which two of the patients were first two splits following technical complications. Two others died, one from cerebral lymphoma and the other of multiorgan failure secondary to sepsis. One patient has been retransplanted for chronic biliary sepsis. CONCLUSION: Split liver transplantation has now become an acceptable treatment option for both adult and pediatric recipients with end stage liver disease. Right lobe recipients are not disadvantaged by the procedure. Good results can be achieved with better patient selection and by the use of good quality organs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bismuth H., Morino M., Castaing D., Gillon M. C., Descorps Declere A., Saliba F., Samuel D. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg. 1989 Jul;76(7):722–724. doi: 10.1002/bjs.1800760723. [DOI] [PubMed] [Google Scholar]
  2. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982 Jan;6(1):3–9. doi: 10.1007/BF01656368. [DOI] [PubMed] [Google Scholar]
  3. Broelsch C. E., Emond J. C., Whitington P. F., Thistlethwaite J. R., Baker A. L., Lichtor J. L. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg. 1990 Sep;212(3):368–377. doi: 10.1097/00000658-199009000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Emond J. C., Whitington P. F., Thistlethwaite J. R., Cherqui D., Alonso E. A., Woodle I. S., Vogelbach P., Busse-Henry S. M., Zucker A. R., Broelsch C. E. Transplantation of two patients with one liver. Analysis of a preliminary experience with 'split-liver' grafting. Ann Surg. 1990 Jul;212(1):14–22. doi: 10.1097/00000658-199007000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kalayoglu M., D'Alessandro A. M., Knechtle S. J., Hoffmann R. M., Pirsch J. D., Judd R. H., Armbrust M., Spaith E., Pilli G., Young C. J. Preliminary experience with split liver transplantation. J Am Coll Surg. 1996 May;182(5):381–387. [PubMed] [Google Scholar]
  6. Karanjia N. D., Shanahan D. J., Knight M. J. Omental patching of a large perforated duodenal ulcer: a new method. Br J Surg. 1993 Jan;80(1):65–65. doi: 10.1002/bjs.1800800123. [DOI] [PubMed] [Google Scholar]
  7. Langnas A. N., Marujo W. C., Inagaki M., Stratta R. J., Wood R. P., Shaw B. W., Jr The results of reduced-size liver transplantation, including split livers, in patients with end-stage liver disease. Transplantation. 1992 Feb;53(2):387–391. doi: 10.1097/00007890-199202010-00023. [DOI] [PubMed] [Google Scholar]
  8. Otte J. B. Is it right to develop living related liver transplantation? Do reduced and split livers not suffice to cover the needs? Transpl Int. 1995;8(1):69–73. doi: 10.1007/BF00366716. [DOI] [PubMed] [Google Scholar]
  9. Otte J. B., de Ville de Goyet J., Alberti D., Balladur P., de Hemptinne B. The concept and technique of the split liver in clinical transplantation. Surgery. 1990 Jun;107(6):605–612. [PubMed] [Google Scholar]
  10. Pichlmayr R., Ringe B., Gubernatis G., Hauss J., Bunzendahl H. Transplantation einer Spenderleber auf zwei Empfänger (Splitting-Transplantation)--Eine neue Methode in der Weiterentwicklung der Lebersegmenttransplantation. Langenbecks Arch Chir. 1988;373(2):127–130. [PubMed] [Google Scholar]
  11. Rat P., Paris P., Friedman S., Favre J. P. Split-liver orthotopic liver transplantation: how to divide the portal pedicle. Surgery. 1992 Sep;112(3):522–526. [PubMed] [Google Scholar]
  12. Rogiers X., Malagó M., Gawad K., Jauch K. W., Olausson M., Knoefel W. T., Gundlach M., Bassas A., Fischer L., Sterneck M. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool. Ann Surg. 1996 Sep;224(3):331–341. doi: 10.1097/00000658-199609000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Slooff M. J. Reduced size liver transplantation, split liver transplantation, and living related liver transplantation in relation to the donor organ shortage. Transpl Int. 1995;8(1):65–68. doi: 10.1007/BF00366715. [DOI] [PubMed] [Google Scholar]
  14. Starzl T. E., Miller C., Broznick B., Makowka L. An improved technique for multiple organ harvesting. Surg Gynecol Obstet. 1987 Oct;165(4):343–348. [PMC free article] [PubMed] [Google Scholar]
  15. de Ville de Goyet J., Hausleithner V., Reding R., Lerut J., Janssen M., Otte J. B. Impact of innovative techniques on the waiting list and results in pediatric liver transplantation. Transplantation. 1993 Nov;56(5):1130–1136. doi: 10.1097/00007890-199311000-00016. [DOI] [PubMed] [Google Scholar]
  16. de Ville de Goyet J. Split liver transplantation in Europe--1988 to 1993. Transplantation. 1995 May 27;59(10):1371–1376. doi: 10.1097/00007890-199505270-00002. [DOI] [PubMed] [Google Scholar]

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