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Split Liver Transplantation Using Hemiliver Graft in the MELD Era: A Single Center Experience in the United States
Author(s) -
Hashimoto K.,
Quintini C.,
Aucejo F. N.,
Fujiki M.,
Diago T.,
Watson M. J.,
Kelly D. M.,
Winans C. G.,
Eghtesad B.,
Fung J. J.,
Miller C. M.
Publication year - 2014
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12791
Subject(s) - medicine , liver transplantation , single center , surgery , model for end stage liver disease , transplantation , liver disease , portal hypertension , cirrhosis
Under the “sickest first” Model for End‐Stage Liver Disease (MELD) allocation, livers amenable to splitting are most often allocated to patients unsuitable for split liver transplantation (SLT). Our experience with SLT using hemilivers was reviewed. From April 2004 to June 2012, we used 25 lobar grafts (10 left lobes and 15 right lobes) for adult‐sized recipients. Twelve recipients were transplanted with primary offers, and 13 were transplanted with leftover grafts. Six grafts were shared with other centers. The data were compared with matched whole liver grafts (n = 121). In 92% of donors, the livers were split in situ . Hemiliver recipients with severe portal hypertension had a greater graft‐to‐recipient weight ratio than those without severe portal hypertension (1.96% vs. 1.40%, p < 0.05). Hemiliver recipients experienced biliary complications more frequently (32.0% vs. 10.7%, p = 0.01); however, the 5‐year graft survival for hemilivers was comparable to whole livers (80.0% vs. 81.5%, p = 0.43). The secondary recipients with leftover grafts did not have increased incidences of graft failure (p = 0.99) or surgical complications (p = 0.43) compared to the primary recipients. In conclusion, while routine application is still controversial due to various challenges, hemiliver SLT can achieve excellent outcomes under the MELD allocation.