Split liver transplantation: a reliable approach to expand donor pool

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Donation

Background:

• Orthotopic liver transplantation faces organ shortages, driving the need for techniques like split liver transplantation.
• Split liver transplantation has matured into a viable surgical option, increasing in European practice from 1.2% to 10.4% between 1993-1999.
• Patient survival rates after split liver transplantation are comparable to whole-organ transplants.

Purpose of the Study:

• To provide guidelines for donor selection in split liver transplantation.
• To outline techniques for hepatic graft splitting.
• To guide recipient management following split liver transplantation.

Main Methods:

• Review of literature from European and American centers specializing in split liver transplantation.
• Analysis of over 10 cases of split liver transplantation experience at the Medical School of Hannover since 1998.
• Evaluation of donor criteria, including age, hemodynamic stability, ICU stay, and serum sodium levels.

Main Results:

• Recommended donor criteria: age <50 years, stable hemodynamics, ICU stay <5 days, Na <170 mmol/L (ideally <150 mmol/L).
• Comparison of in situ versus ex situ (bench) splitting techniques, with equivalent transplant outcomes for ex situ.
• Introduction of new techniques like split-cava for splitting a liver between two adult recipients.

Conclusions:

• Timeliness of liver transplantation is the most critical prognostic factor, not the type of transplant.
• Graft-to-recipient weight ratio (GRWR) and patient scoring systems (UNOS/MELD) require careful consideration before split liver transplantation.