Split Liver Transplantation for Two Adult Recipients

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Split Liver Transplantation for Two Adult Recipients: An Initial

Experience



Abhinav Humar*, Thiagarajan Ramcharan, Timothy D. Sielaff, Raja

Kandaswamy, Rainer W. Gruessner, John R. Lake and William D. Payne



Department of Surgery, University of Minnesota, MN, USA



The shortage of cadaver donor livers has been most severe for adult

patients. Split liver transplantation is one method to expand the donor

pool, but to have a significant impact on the waiting list, it needs to be

applied for 2 adult recipients.



We split livers from 6 cadaver donors, and transplanted 12 adult

recipients. All splits were performed in situ with transection through the midplane of the liver, resulting in a right lobe and a left lobe graft. Mean donor age was 19.7 years; mean donor weight was 79.1 kg. Mean recipient age was 41.5 years. Mean weight of right lobe recipients was 89 kg; left lobe recipients, 60 kg. All donors were hemodynamically stable and had normal liver function tests. Mean operative time for the procurement was 7.4 h. Average blood loss during the transection of the liver was 490 mL. Mean GW/RW ratio for all recipients was 0.87%; right lobe recipients, 0.86%; and left lobe recipients, 0.88%. With mean follow-up of 9.3 months, patient and

graft survival rates were both 83.3%. There were 2 deaths: 1 after hepatic artery thrombosis (HAT) and subsequent multiorgan failure; the other after HAT, a liver retransplant, and subsequent gram-negative sepsis. The remaining 10 recipients are doing well. We observed no cases of primary nonfunction. Other complications included bile leak and/or stenosis (n = 3), bleeding from the Roux loop (n = 1), bleeding after percutaneous biopsy (n = 1), and incisional hernia (n = 1). In conclusion, split liver transplantation, using 1 cadaver liver for 2 adult recipients, can be performed successfully. Crucial to success is proper donor and recipient selection.



American Journal of Transplantation 1 (4), 366-372 © Munksgaard, 2001





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