Split liver is an effective tool to transplant paediatric patients

Area of Science:

• Transplantation Surgery
• Hepatology
• Organ Procurement

Background:

• Cadaver donor organ pool is insufficient for recipient needs, particularly for pediatric liver transplantation.
• High mortality rates exist for children awaiting liver transplants due to limited donor availability.
• The split-liver procedure was developed to maximize organ utilization from a single donor.

Purpose of the Study:

• To evaluate the effectiveness of a Split-Liver Program initiated by the North Italy Transplant program (NITp).
• To assess the impact of split-liver transplantation on reducing waiting times for pediatric patients.
• To analyze graft survival rates and patient outcomes in both pediatric and adult recipients.

Main Methods:

• A Split-Liver Program protocol was established with defined donor and recipient eligibility criteria.
• The study analyzed data from 410 cadaver liver donors between November 1997 and May 1999.
• The split-liver procedure was performed using an "in situ" technique in most cases, with lobes allocated to adult and pediatric recipients.

Main Results:

• 49 split-liver procedures were performed, utilizing 49 donors to transplant 49 adults and 43 children.
• In the pediatric group, graft survival was 79%, with a 10.2% mortality rate.
• In the adult group, graft survival was 67.3%, with a 22% mortality rate.
• Mean waiting time for pediatric patients decreased significantly after program implementation.

Conclusions:

• Split-liver transplantation is a successful strategy for increasing liver organ availability.
• The procedure significantly reduces waiting times for pediatric liver transplant candidates.
• Further investigation is warranted to determine its utility for expanding the organ pool for adult liver transplantation.