Right-Left in-situ split for liver transplantation. First case in Argentina

Abstract

Introduction: Despite the efforts to increase the deceased donors, patients in waiting list overcome the current availability of cadaveric donors. Many alternatives have been described in order to increase the pool of organs. Split organs have been worldwide accepted. Right-Left (R-L) split allows to obtain two grafts with the potential of been distributed among adult recipients. Here we aim to report the outcome of the first in situ RL split done in Argentina. Case report: Adult ideal donor was offer to a 9-year-old male with cyst fibrosis and cirrhosis, based on his anthropometry, the need for using a LL was considered. The RL was finally assigned to a 54-year-old female with unresectable NET liver metastases. Donor and recipient's characteristics are show in table 1. At the procurement, no vascular variations were found; a hanging maneuver was used. IVC was left to the left graft. During the back table: the celiac axis and portal vein were left in the RL. RL weight: 950grs, LL graft was 450 grs. LL was engrafted using Piggy back; arterial reconstruction was done to recipient's left hepatic artery; and a Roux-Y was performed; GRWR: 1.6; TIT: 505min. RL engraftment was also done with Piggy back; cavoplasty was done to improve liver outflow; and a Duct-to-duct anastomosis with T-tube was done; GRWR: 1.4; TIT: 515 min. No reoperations were needed. Conclusion: R-L Split grafts are a valid alternative to improve the pool of donors. Recipients might be carefully selected to obtain well results.