SPLIT LIVER TRANSPLANTATION WITH PEDIATRIC DONORS: RESULTS OF A MULTICENTRIC EXPERIENCE.

Abstract

O26* Aims: To report the results of split liver transplantation (SLT) with pediatric donors, in particular those performed with donors aged 10 years or less, the use of which is currently not recommended. Methods: From October 1997 to August 2003, on a total of 186 split liver procedures performed by the Bergamo transplant team alone or in collaboration with other liver transplant centers, 39 (21%) were carried out using donors aged < 15 years. In all cases the procedure generated a left lateral segment (segments II-III [LLS]) and an extended right graft (segments I+IV-VIII [ERG]). In 3 cases, no suitable recipient was found for the ERG and only the LLS was transplanted. Criteria for splitting were donor hemodynamic stability with normal liver function, and dimensional matching based on donor-to-recipient weight ratio. In all but one case the celiac trunk was maintained with LLS. Recipient population included 47 children receiving 39 LLS and 8 ERG, and 28 adults transplanted with ERG. SLT were performed with 16 donors ≤ 10 years of age (mean weight 31 ± 9 kg) and with 23 between 11 and 15 years (mean weight 57 ±11 kg). There were no differences among groups in pre-transplant patient status, cause of liver failure, primary or secondary SLT, and procurement parameters. Results: Median recipients follow up was 19 months (1-70). Two-year patient and graft survival are reported in the following table.FigureArterial complications (AC) occurred in 6% of the patients receiving split liver graft from pediatric donors (8% in the ≤ 10 years donors group, and 5% in the 10-15 years donors group). Recipient of LLS developed AC in 3% of the cases, while ERG recipients had AC in 12% of the cases. The incidence of surgical and infectious complications was also similar among groups. Conclusions: The use of pediatric donor for SLT allows obtaining good results, comparable to those achieved with SLT using adult donors. The similar incidence of AC among patients receiving LLS or ERG further supports the policy of maintaining the celiac trunk with LLS. Transplantation, Volume 78, Number 2, July 27, 2004