Extension of the adult hepatic allograft pool using split liver transplantation.

BACKGROUND: The ever increasing number of, especially, adults waiting for a liver transplantation necessitates to develop techniques allowing to extend the available donor liver pool. MATERIALS AND METHODS: Between November 1988 and December 2004, 37 (6.6%) of 559 adults underwent split liver transplantation at Saint-Luc Hospitals. There were 36 were right and one left split procedures; 27 split grafts were obtained ex-situ and 10 in-situ. Results of these series are analysed and compared to literature data of split liver transplantation. RESULTS: Three and 12 months patient survival rates were 89.2% and 78.4% respectively. Five years actuarial patient survival was 75.7%. Early (< 3 months) and late (> 3 months) mortality rates were 10.8% (4 pat.) and 21.6% respectively. Early mortality was significantly higher in case of urgent split liver transplantation (3/5 patients vs. 2/32 elective patients--p 0.001). At present 25 patients are alive, with a mean Karnofsky score of 90%. Three and 12 months graft survival rates were 91.7% and 87.1% respectively. Three and one grafts were lost due to primary and early graft non-function. In-situ split grafts had shorter mean warm, cold, total ischemia and operating times as well as less need for blood transfusion; all these differences were however not statistically significant. Surgical complications occurred in 19 (51%) patients. All but one complication occurred early (< 3 months). There were sixteen biliary complications in 13 (35.1%) patients: 9 anastomotic stenoses, 3 anastomotic and 4 transection margin leakages. Six vascular complications occurred in 6 (15.2%) patients: three arterial and 3 portal vein thromboses. Seven (18.9%) patients had a postoperative bleeding. CONCLUSIONS: Graft and patient survival rates of split liver transplantation can be compared to those of classic liver transplantation. However the care of these patients is demanding due to the high number of technical complications. Results of split liver transplantation must be further improved in order to foster it's more widespread use necessary to overcome the actual shortage of liver allografts.