Results in split liver transplantation

Abstract

Introduction The shortage in cadaveric grafts has prompted the development of alternative surgical techniques to expand the donor pool. Objective To evaluate the feasibility of split liver transplantation using an observational, retrospective, and longitudinal study. Materials and methods Between April 1986 and October 2002 we performed 875 liver transplants. From April 1991 to date, we performed 18 split liver transplantations in patients of mean age 42.27 ± 25.65 years; five children and 13 adults; and 83.3% women. Urgent transplants accounted for 38.9%. Mean patient weight was 52.29 ± 20.87 kg. Ex situ splitting was performed in 33%. The mean cold ischemia time was 460 ± 265.69 minutes with a mean warm time of 64.33 ± 11.78 minutes. Mean consumption of packed blood was 5.59 ± 4.87 units; of frozen fresh plasma, 11.56 ± 7.42 units; and of platelets 4.89 ± 4.99 units. Results After a mean follow-up of 10.83 ± 12.51 months, 55.56% of the recipients are alive. Actuarial patient and graft survival rates at 1 year are 55.6% and 44.12%, respectively. Actuarial patient and graft survival rates at 1 year, excluding operative mortality were 77% and 68%, respectively. Actuarial patient and graft survival rates at 1 year, comparing urgent and elective transplantations are: 14.29 and 14%, respectively, for urgent cases and 90.91 and 90% for elective ones. Operative mortality was 16.6% while mortality during follow-up was 26.6%. The late complications included arterial thrombosis ( n = 2): of whom the first needed liver retransplantation 4 months after split liver transplantation; chronic rejection ( n = 2), recurrence of hepatitis ( n = 1). Conclusions Split liver transplantation is a useful way to expand the graft pool and shows better results in elective liver transplantation.