Outcomes With Split Liver Transplantation in 106 Recipients The University of California, San Francisco, Experience From 1993 to 2010
ABSTRACT Split liver transplantation (SLT) allows for expansion of the deceased donor pool.
To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients.
Single-center retrospective review (September 18, 1993, to July 1, 2010).
University medical center.
One hundred six SLT recipients.
Postoperative graft and patient survival and postoperative complications.
In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n = 1), need for shunt at the time of SLT (n = 1), and primary nonfunction (n = 1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n = 1).
Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.
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ABSTRACT: Split liver transplantation (SLT) using extended right grafts is associated with complications related to ischemia of hepatic segment 4 (S4), and these complications are associated with poor outcomes. We retrospectively analyzed 36 SLT recipients so that we could assess the association of radiological, biological, and clinical features with S4 ischemia. The overall survival rates were 84.2%, 84.2%, and 77.7% at 1, 3, and 5 years, respectively. The recipients were mostly male (24/36 or 67%) and had a median age of 52 years (range = 13-63 years), a median body mass index of 22.9 kg/m(2) (range = 17.3-29.8 kg/m(2) ), and a median graft-to-recipient weight ratio of 1.3% (range = 0.9%-1.9%). S4-related complications were diagnosed in 22% of the patients (8/36) with a median delay of 22 days (range = 10-30 days). Secondary arterial complications were seen in 3 of these patients and led to significantly decreased graft survival in comparison with the graft survival of patients without complications (50.0% versus 85.6%, P = 0.017). Patients developing S4-related complications had significantly elevated aspartate aminotransferase (AST) levels (>1000 IU/L) on postoperative day (POD) 1 and elevated gamma-glutamyl transpeptidase (GGT) levels (>300 IU/L) on PODs 7 and 10 (P < 0.05). These AST and GGT elevations conferred a significantly high risk of developing these complications (odds ratio = 42, 95% confidence interval = 4-475, P < 0.05). The ischemic volume of S4 was extremely variable (0%-95%) and did not correlate with S4-related complications. In conclusion, our results suggest that S4-related complications are risk factors for worse graft survival, and the development of these complications can be anticipated by the early identification of a specific biological profile and a routine radiological examination.Liver Transplantation 04/2012; 18(4):413-22. DOI:10.1002/lt.22479 · 3.79 Impact Factor
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ABSTRACT: In the last three decades, the management of human immunodeficiency virus (HIV) has improved dramatically. The use of combination antiretroviral therapy (ART) has been successful at preventing death and the myriad infectious, malignant, and immune-mediated complications of HIV. Once considered to be a fatal disease, HIV is now considered by many to be a chronic disease; those affected may now live to experience complications of other coexistent diseases. Liver disease has been increasingly recognized as a leading cause of non-HIV/acquired immunodeficiency syndrome- (AIDS-) related morbidity and mortality in this population.Although liver transplantation offers the opportunity to prolong life, the transplant community has been slow to recognize the chronicity of HIV and potential for transplantation within this population. The experience with liver transplantation in HIV-positive patients is evolving and successful outcomes have been observed when specific criteria are used to select candidates.Seminars in Liver Disease 05/2012; 32(2):177-85. DOI:10.1055/s-0032-1316474 · 5.12 Impact Factor
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ABSTRACT: Although there is a worldwide need to expand the donor pool, many cadaveric marginal livers are usually discarded for transplantation. Herein, we report the outcome of a series of patients receiving marginal grafts. We analyzed all patients who underwent liver transplantation in our unit from August 2006 to March 2011 (n = 125) with the use of a prospectively collected database. Patients with ≥3 of donor (prolonged hypotensive episodes, donor age >55 years, high vasopressor drug requirement, hypernatremia, prolonged intensive care unit stay, elevated transaminases) and graft-related (cold ischemia >12 hours, warm ischemia time >40 minutes and steatosis >30%) extended criteria were defined as extremely marginal liver grafts (EMLG). The outcomes of patients receiving EMLG were compared with the recipients of grafts without any marginal criteria (ideal grafts). The EMLG group (n = 36) showed higher operative transfusion requirement (66.6% vs 55.6%) as well as 30-day (11.1% vs 55%) and 1-year (22.2% vs 5.5%) mortality rates, compared with the ideal grafts group (n = 18) but without a significant difference. Other variables, such as major complications, postoperative hemodialysis, ICU and hospital stay, and 1-year survival also were not significantly different. The liver pool can be safely expanded using EMLG from deceased donors for liver transplantation. These usually discarded liver grafts showed similar early and long-term outcomes compared with ideal organs.Transplantation Proceedings 09/2012; 44(7):2219-22. DOI:10.1016/j.transproceed.2012.07.113 · 0.95 Impact Factor