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L/I‐11
Simultaneous adult‐to‐adult (A/A) split liver transplants
Author(s) -
Panaro F.,
Andorno E.,
Ravazzoni F.,
Di Domenico S.,
Ghinolfi D.,
Miggino M.,
Morelli N.,
Bottino G.,
Casaccia M.,
Valente U.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00577_3_11.x
Subject(s) - medicine , surgery , liver transplantation , transplantation , organ procurement
Split liver transplants (SLTs) and living related liver transplants (LRLTs) were developed to increase the number of available organs for adult recipients. We review our experience in performing both the split procedure and the 2‐graft transplant at the same division. Patients and methods: From 1997 to 2005, we performed 96 in situ SLTs (82 adult donor‐to‐pediatric recipient [A/P] and 14 adult‐to‐adult [A/A]). We used 9 right grafts (SV‐VIII) and 5 left grafts (SI‐IV) for the A/A group. Two of these grafts were procured from a single donor and transplanted into 2 recipients by our team. The in situ SL procedure was performed in the emergency department OR and the 2 transplants in our dedicated ORs. Results: The splitting procedure required 110 minutes with a blood loss of 350 ml. The entire procedure (from procurement to last transplant) took 18 hours to be completed. Donor : 17 yrs, 170 cm,78 kg, ICU stay 2 days, SLV 1341 gr (right 737 gr, left 604 gr). Recipients : see below. The overall survival rate of the A/A group was 66% for right grafts (median follow‐up, 46 months) and 80% for left grafts (median follow‐up, 62 months). The recipients with the same donor are still alive with normal LFTs at 47 months posttransplant. Conclusion: A “simultaneous” transplant of 2 liver grafts at the same center may increase graft quality and improve organ survival. Conversely, it requires excellent technical facilities and organizational skills. This approach has the potential to decrease mortality on the adult waiting list, to optimize LT timing with outcome improvement, and to decrease the need for LRLDs.Left Graft Recipient Right Graft RecipientGraft weight (gr) 600 580 Age (yrs) 51 53 Diagnosis HCV+ALCOHOL HCV+HBV+HDV+ALCOHOL Status/MELD 2B/13 3/14 Weight (kg) 56 57 GRWR (%) 1.07 0.98 Blood transfusions (units) 11 6 Length (h) 6h36min 9h30min Discharge (POD) 23 58* Liver volume after 2 mos 1515 ml 1522 ml*comorbidity: renal failure requiring hemodialysis. *Chi‐squared p = .046 comparing Clavien 0/I vs. II/III/IV.