Split and living donor liver transplantation

Abstract

The split liver transplant allows for the division of a graft in two parts, usually the right side for an adult and the left side for use in a child. To date, many centres have confirmed the efficacy and safety of the procedure. However, the highly demanding surgery and the relatively low activity, associated with the low number of ideal donors, and few adequate recipients, and most of all, the compromised long-term outcome, have resulted in a significant decrease of adult to adult split liver transplantation. The real incidence of morbidity and mortality has been a matter of controversy. While some authors suggest a 15% morbidity rate, others have pointed out a higher incidence reaching up to 70%. Recent data, however, show that at least 38% of all donors had some type of complication: The official European Liver Transplant Registry (ELTR) guarantees that the mortality rate associated to the donor operation is well established in Europe (0.2%, 1997–2007). To date post-transplant survival at one and three years are 92% and 84.8% respectively. To summarize, currently, adult living donor liver transplantation has the same probability of survival at 1 and 5 years when compared to deceased donor liver transplantation.