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Worth continuing doing ex situ liver graft splitting? A single-center analysis
Huda M Noujaim1, Bridget Gunson, David A Mayer
1Liver Unit Birmingham Children's Hospital, Birmingham, UK.
Summary
Ex situ liver division for split liver transplantation (SLT) offers improved outcomes. This method resulted in fewer vascular complications and enhanced 1-year graft survival compared to earlier practices.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Surgical Techniques
Background:
- Split liver transplantation (SLT) involves preparing grafts either in situ or ex situ.
- The in situ technique offers theoretical benefits like reduced cold ischemic time but presents practical challenges.
- Ex situ liver division, performed on a back table, has been refined through protocol updates.
Purpose of the Study:
- To compare the outcomes of ex situ liver division before and after implementing a new protocol.
- To evaluate the impact of procedural changes on vascular complications and graft survival in SLT.
Main Methods:
- Retrospective analysis of 89 split liver transplants conducted at a single center.
- Comparison of outcomes between two groups: Group I (1992-1997) and Group II (1998-2001) representing pre- and post-protocol implementation.
Main Results:
- Group II demonstrated significantly lower vascular complication rates (3.3% vs. 20%, p=0.04).
- One-year graft survival improved from 59% in Group I to 78% in Group II (p=0.03).
- Post-1998 SLT graft survival (78%) was comparable to conventional liver transplantation (74%).
Conclusions:
- Ex situ liver division can achieve excellent results in split liver transplantation.
- The refined ex situ technique is a viable and effective alternative when in situ preparation is not feasible.