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Split liver transplantation for two adult recipients
Sheung-Tat Fan1, Chung-Mau Lo, Chi-Leung Liu
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. hrmsfst@hkucc.hku.hk
Hepato-Gastroenterology
|March 13, 2003
Summary
Split liver transplantation enabled two adults to receive grafts. However, the left lobe graft faced complications, highlighting the need for improved hepatic vein drainage design in split liver grafts for better outcomes.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Surgical Anatomy
Background:
- Split liver transplantation is a strategy to increase donor liver utilization for two recipients.
- This case involved splitting a single liver graft for two adult patients with different end-stage liver diseases.
Observation:
- A 1285g liver graft was divided into a right lobe (900g) and a left lobe (385g).
- The right lobe graft was successfully transplanted into a patient with hepatitis B cirrhosis.
- The left lobe graft recipient experienced massive bleeding and segment 4 congestion, with Doppler ultrasonography revealing reversed portal vein flow in segment 4.
Findings:
- The right lobe graft implantation was uneventful.
- The left lobe graft, lacking the middle hepatic vein, presented significant surgical challenges.
- Despite initial complications, both recipients survived the surgical procedures.
Implications:
- This case underscores the critical importance of adequate hepatic vein drainage, particularly for segment 4 in left lobe grafts.
- Optimizing the vascular reconstruction, specifically hepatic vein management, is crucial for successful split liver transplantation in adults.
- Future strategies should focus on enhancing graft design to ensure sufficient venous outflow for all liver segments in both recipients.