Split-liver transplantation for two adult recipients: Feasibility and long-term outcomes

Objective To identify the outcomes and risks of split-liver transplantation (SLT) for two adult recipients to determine the feasibility of more widesp read use of this procedure to increase the graft pool for adults. Summary Background Data The shortage of cadaver liver grafts for adults is increasing. Using livers from donors defined as optimal, the authors have b een developing techniques for SLT for two adult recipients at their center. Methods From July 1993 to December 1999, 34 adults have undergone SLT with grafts from optimal donors prepared by ex situ split (n = 30) or in situ sp lit (n = 4), and 88 adults received optimal whole-liver grafts that were no t split. Four split-grafts were transplanted at other centers. The outcomes of transplantation with right and left split-liver grafts were compared wi th those of whole-liver transplants. The main end points were patient and g raft survival at 1 and 2 years and the incidence and types of complications . Results For whole-liver, right and left split-liver grafts, respectively, p atient survival rates were 88%, 74%, and 88% at 1 year and 85%, 74%, and 64 % at 2 years. Graft survival rates were 88%, 74%, and 75% at 1 year and 85% , 74%, and 43% at 2 years. Patient survival was adversely affected by graft steatosis and recipients inpatient status before transplantation. Graft su rvival was adversely affected by steatosis and a graft-to-recipient body we ight ratio of less than 1%. Primary nonfunction occurred in three left spli t-liver grafts. The rates of arterial (6%) and biliary (22%) complications were similar to published data from conventional transplantation for an adu lt and a child. SLT for two adults increased the number of recipients by 62 % compared with whole-liver transplantation and was logistically possible i n 16 of the 104 (15%) optimal cadaver donors. Conclusions Split-liver transplantation for two adults is technically feasi ble. Outcomes and complication rates can be improved by rigid selection cri teria for donors and recipients, particularly for the smaller left graft, a nd possibly also by in situ splitting in cadaver donors. Wider use will req uire changes in the procedures for graft allocation and coordination betwee n centers experienced in the techniques.