First simultaneous and synchronized split-liver transplantation involving two recipients and three surgeons in Costa Rica: A case report

Abstract

BackgroundCosta Rica has a public health system based on social security, and its transplant program has limited resources. Therefore, when a whole liver is surgically split for transplantation, only one of the obtained grafts can be transplanted. In Costa Rica, there are only three surgeons with expertise and surgical training in liver transplantation with living-donor and split-liver transplantation (SLT) for both pediatric and adult patients. To overcome the existing limitations and the low organ donation rate, a strategy designed to maximize the use of split grafts for liver transplantation was created. This strategy involves the performance of two simultaneous and synchronized SLTs in parallel at two different hospitals. MethodsThis strategy was performed for the first time in May 2018. Simultaneously and synchronously, two SLTs were performed for a woman and a female infant; both patients underwent operations at the same time by only three transplant surgeons in two different hospitals. ResultsThis strategy allowed the performance of two SLTs without compromising the cold ischemia time (CIT) or reperfusion. The infant and woman had a CIT time of 4.5 and 6.0 h, respectively. At 16 months postoperatively, both patients had excellent quality of life and graft function. ConclusionThis first experience with the herein-described surgical and logistical strategy, although successful, requires institutional and governmental support so that the outcomes can be improved to maximize the benefit and opportunity of access for patients on the waiting list for liver transplantation in health systems of third-world countries with limited resources.