Outcome of other organs recovered during in situ split-liver procurements

Split-liver transplantation is becoming a useful technique to expand the do nor pool. Whether the split should be performed in situ or ex situ is not d ear. One potential disadvantage of in situ splits is that prolonged surgica l time and increased blood loss may negatively affect the function of other solid organs (kidneys, pancreas, and heart) procured from the same donor. Therefore, we studied the function of other organs posttransplantation. Bet ween September 1, 1999, and March 31, 2000, we performed six in situ splits at the University of Minnesota (Minneapolis, MN). These six splits yielded six right-lobe liver grafts and six left-lobe liver grafts, which were tra nsplanted into 12 adult-size recipients. Other grafts obtained from these s ix donors were as follows: kidney (n = 11), heart (n = 4), lungs (n = 1), p ancreas (n = 2), and kidney-pancreas (n = 1). We then analyzed posttranspla ntation function of these grafts and the postoperative course of transplant recipients. All six donors were hemodynamically stable at the time of proc urement. Mean donor age was 19.7 years. Mean surgical time for the procurem ent was 7.4 hours, with an average blood loss of 490 mL during in situ spli tting of the liver. The 12 liver grafts showed good initial function with n o primary nonfunction. The other organs also showed good function. Of 11 ki dney recipients, only 1 patient developed delayed graft function, which res olved within 4 days. In addition, 1 kidney was lost early because of severe acute rejection. For the 10 recipients with functioning kidneys, mean crea tinine level at hospital discharge was 2.0 mg/dL, and mean creatinine level after an average 9-month follow-up was 1.3 mg/dL. Of the 4 heart transplan t recipients, 3 patients had good graft function immediately posttransplant ation, with an ejection fraction greater than 60%, minimal inotropic requir ements, and no surgical complications. The fourth heart transplant recipien t, a critically ill status 1 patient, had poor initial function and a prolo nged intensive care unit stay. At hospital discharge, pancreas and pancreas -kidney transplant recipients were all insulin free, with good urine amylas e levels, no surgical or infectious complications, and no evidence of signi ficant pancreatitis posttransplantation. The kidney of the pancreas-kidney transplant recipient functioned immediately, creatinine level after 7 month s of follow-up was 1.2 mg/dL. Despite increased surgical time and blood los s, in situ splitting of liver grafts can be accomplished in stable donors w ithout significant negative effects on other organs.