ENCOURAGING RESULTS OF SPLIT-LIVER TRANSPLANTATION

Background Liver donor shortage presently accounts for a 10 per cent w aiting list mortality rate. Split-liver transplantation (SLT) can impr ove utilization of this scarce resource. Methods Twenty-four SLTs (11 left, 13 right grafts) from 13 livers were performed in 23 patients (n ine adults, 14 children), comprising 45 per cent of all orthotopic liv er transplants (14 urgent or emergency, ten elective), The left graft comprised segments II and III, whereas the right graft comprised segme nts V-VIII in eight cases, IV-VIII in three, and segments I, IV-VIII, and I, V-VIII in one case each, Additional arterial extension grafts w ere required in six of 24 cases, and portal venous interposition graft in one. Results Twenty-one grafts showed good initial function, with one primary non-function and two initial poor function. The median pea k aspartate aminotransferase level was 782 (range 94-2301) and 982 (ra nge 382-2520) units/1 for left and right grafts respectively. Five pat ients died tall urgent recipients), all within the first 30 days after surgery. Two SLT recipients underwent subsequent retransplantation. A ll ten elective recipients are alive The 1-year actuarial patient and graft survival rates at a median follow-up of 20 months were 78 and 68 per cent respectively. Conclusion These encouraging results compare f avourably with those of reduced-size and whole-liver transplantation a nd justify wider application of this technique, thereby optimizing don or resource use.