IN-SITU SPLITTING OF CADAVERIC LIVERS - THE ULTIMATE EXPANSION OF A LIMITED DONOR POOL

Objective The authors evaluate the safety, applicability, and effectiv eness of anew technique for split-liver transplantation. Summary Backg round Data Split-liver transplantation offers an attractive way to inc rease the donor pool for cadaveric liver transplantation. The applicat ion of this concept has been hampered by inferior patient and graft su rvivals and higher complication rates. Without supportive data, the co ncern about increasing biliary leakage and poor initial graft function persisted. The authors focused on the causes of these complications b y presenting a new technique to eliminate these problems. Methods Live r splitting was performed in the heart-beating cadaveric organ donor, using the technique described for procurement of the left lateral lobe of a live donor. A detailed description of the technique is presented . A retrospective review of the first 14 transplantations resulting fr om 7 in situ splitting procedures was collected. The results were comp ared with 19 conventional split-liver transplants performed during the same period. Results Six-month patient and graft survivals after in s itu split-liver transplantation were 92.8% and 85.7%, respectively. Bi liary complications were absent. Postoperative courses were mostly une ventful and characterized by lower peak transaminase levels compared w ith standard techniques. Early graft function of extrahepatic organs p rocured simultaneously was excellent. Conclusions In situ split-liver transplantation provides superior results, related mainly to reduction of cold ischemic damage of the grafts and avoidance of biliary compli cations. In situ split-liver transplantation renders graft reduction a lone obsolete and opens a donor pool for adults to receive right lobes safely. It allows for long-distance sharing between pediatric and adu lt liver transplant units because the procedure abolishes ex situ benc hing and prolonged ischemia time and provides two anatomically perfect grafts with hemostasis accomplished.