Surgical Aspects of Split Liver Transplantation

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Abstract

Introduction

Split liver transplantation is the important component of developed liver transplant program, which allows to increase the effectiveness of deceased donation. Nevertheless, at the present time there is absence of common concept of donor selection for liver transsection into two viable fragments. The “classical split” in left lateral section (LLS) and extended right lobe (ERL) is most preperable type of this procedure. The surgical issues of graft splitting discussed are “ in situ/ex situ” division .

Purpose

to analyze the surgical aspects of obtaining two grafts from the split liver from deceased donors in single center.

Materials and methods

Since June 2008 to October 2017, 16 cases of split liver transplantation were performed. 12 SLT of them were performed in 2016 and 2017. That allowed to make transplantations of liver fragments in 34 recipients. The age of deceased donors was between 18 and 54 years (25 ± 5 years). In eleven cases, parenchyma transsection was performed completely in situ. During in situ splitting the conversion to ex situ was performed due to the hemodynamic instability of the donor in 3 cases. When parenchyma transsection was finished on the back bench after organ explantation and flashing (ex situ). The liver graft was divided into the LLS and ERL completely ex situ on the back bench (I, IV-VII segments) in 3 cases.

Materials and methods

The age of LLS recipients ranged from 6 months to 6 years (mean 22 months), weight - from 5 to 16 kg (mean 9,4 ± 3,9 kg). The age of ERL recipients was from 8 to 54 years (mean 17 years), and weight was from 21 to 65 kg (mean 39 ± 11,9 kg).

Results

The protocol of the deceased donor selection for split liver transplantation was proposed. Small-for-size syndrome wasn’t observed in this series. The follow up without complications was observed in 20 of 32 recipient. 1-, 3-, 5- y graft and recipient survival was 85.3%, 85.3% and 79.4% respectively.

Conclusion

Split liver transplantation is an effective method viable recipients with terminal stage liver disease. Division of liver in LLS and ERL allows to obtain two quality grafts for transplantation and to prevent small-for size syndrome in recipient. In situ/ex situ splitting doesn’t influence on result.

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