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Split Liver Transplant From Deceased Marginal Donor: A Case Report.

Cihan Karatas1, A Alim1, T Yildirimoglu1

  • 1Koç University, Faculty of Medicine, Liver Transplantation Center, Istanbul, Turkey.

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|March 14, 2022
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Summary

Splitting marginal donor livers, even with multiple risk factors like severe hypernatremia, can be successful. This approach offers a viable option for select pediatric and adult recipients facing organ shortages.

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Area of Science:

  • Transplantation immunology and surgery
  • Hepatology and liver disease management
  • Organ donor criteria and utilization

Background:

  • Increasing demand for deceased donor organs due to rising cirrhosis rates.
  • Growing consideration of marginal donor livers (elderly, ICU stay, steatosis, hypernatremia, inotropes) despite debate on splitting them.
  • Need for innovative strategies to address organ scarcity in liver transplantation.

Observation:

  • A 28-year-old deceased donor with traumatic brain injury, 3-day ICU stay, severe hypernatremia (188 mEq/L), and inotropic support.
  • Procured liver showed 5% necrosis on core biopsies.
  • Graft was split into a left lateral segment and an extended right lobe.

Findings:

  • Successful split liver transplant performed on a 4-year-old child with secondary biliary cirrhosis and an adult with hepatocellular carcinoma.
  • Both recipients experienced uneventful post-transplant recovery and were discharged.
  • Normal liver function tests maintained during a 2-year follow-up period.

Implications:

  • Marginal donor livers, even with multiple risk factors, should not be automatically discarded.
  • Selective splitting of such grafts can expand the donor pool and benefit highly selected recipients.
  • This case highlights the potential of split liver transplantation to improve outcomes in organ-scarce environments.