Current status of deceased donor split liver transplantation in Japan

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Abstract

Background

The aim of this study was to analyze the outcomes of deceased donor split liver transplantation (LT) in Japan.

Methods

Among 257 deceased donor LTs, 36 recipients underwent split LT until the end of 2014. The clinical data of donors and recipients were collected from the national organ transplant network and 11 liver transplant institutions, and the outcomes of split LT were evaluated.

Results

Most of the whole livers were divided using the ex-situ splitting technique. Twelve livers were divided to left lateral segment/extended right lobe grafts and six livers to left lobe/right lobe grafts. The common underlying liver diseases consisted of graft failure in 11 patients, followed by acute liver failure in nine. Seventeen cases (48.6%) suffered from surgical complications, including biliary complications in six, all of which occurred in the cases receiving right-sided lobe grafts; intra-abdominal hemorrhage in five; and vascular complications in four. The overall graft 1-year and 3-year survival rates were 91.0% and 87.1%, respectively.

Conclusions

An initial experience of deceased donor split LT in Japan shows acceptable outcomes despite the high incidence of surgical complications. Further advances in the development of the splitting technique are necessary to expand the application of split LT.

Highlight

This nationwide survey by Sakamoto and colleagues of deceased donor split liver transplantation in Japan revealed acceptable outcomes, suggesting that split liver transplantation could be an excellent option to expand the limited donor pool. The high incidence of surgical complications, however, must be resolved before wider application can be achieved.

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