By Liz Highleyman

Due to a severe worldwide shortage of donor livers for transplantation, researchers have explored split-liver transplants, which involved dividing a single donor liver into 2 pieces and transplanting these into different recipients. Typically, this is done by giving the smaller piece to a child and the larger piece to an adult, but transplants to 2 adult recipient have also been done.

A group of surgeons and researchers from Italy described a decade experience with split-liver transplants at the 43rd annual meeting of the European Association for the Study of the Liver (EASL) last week in Milan.

As background, the researchers noted that at the 9 liver transplant centers participating in their program, conventional (adult/pediatric) split-liver transplantation began in 1997, while non-conventional (adult/adult) split-liver transplantation was introduced in 1999.

All split-liver and whole-liver transplants from cadaver donors performed at the centers between November 1997 and December 2006 were included in the analysis.

Conventional split-liver transplants were classified as LLS (segments II-III for a pediatric recipient) and RTL (segments I, IV-VIII for an adult recipient). Non-conventional split-liver transplants for 2 adult recipients were reported as MSL (segments V-VIII) or (segments I-IV).

The outcome of first transplants was compared with that of re-transplantation, and the outcome of the first 20 conventional split-liver transplants (considered the learning phase) was compared with the subsequent activity in each center that performed at least 40 conventional split-liver transplants.

Results

• During the analysis period 601 split-liver transplants (551 conventional and 50 non-conventional) and 2657 whole-liver transplants were performed.

• Out of 601 split-liver transplants, 538 (89.5%) were first transplants and 63 (10.5%) were re-transplants.

• Among the whole-liver procedures, 2440 (92%) were first transplants and 217 (8%) were re-transplantation.

• 449 pediatric recipients were transplanted with the following liver grafts: 154 whole liver, 275 LLS, 16 RTL, and 4 MSL.

• 2809 adult recipients received the following: 2503 whole liver, 3 LLS, 257 RTL, and 46 MSL.

• In conventional split-liver transplants, patient survival was not significantly different with split-liver or whole liver transplantation.

• 3-year graft survival of split-liver transplant recipients was significantly higher for the first transplants compared with the re-transplants (75.6% vs 41.3%; P<0.05).

• 3-year graft survival of whole liver transplant recipients was 76%.

• In the 5 centers that performed at least 40 conventional split-liver transplants, graft survival improved after the learning phase, from 70% to 79%.

Conclusion

Based on these findings, the researchers conclude, "In our 10-year experience, conventional split-liver transplantation outcome is comparable to that of whole-liver and hence, all livers meeting suitability criteria should be used as split-liver transplants to increase the availability of grafts for transplantation."

Department of Regenerative Medicine, Transplantation Immunology, Fond. IRCCS Ospedale Maggiore Policlinico, MaRe, Milan, Italy; Liver and Lung Transplant Center, AO Ospedali Riuniti, Bergamo, Italy; Transplant Center, AO Univ. San Martino, Genova, Italy; Liver Transplantation and Surgery, AO Niguarda, Milan, Italy; Hepatobiliary Surgery and Liver Transplantation, AO Padua, Padua, Italy; Liver Transplantation Center, Fond. IRCCS Ospedale Maggiore Policlinico, MaRe, Milan, Italy; Department Of Transplantation, University Hospital, Undine, Italy; Department Of Surgery and Liver Transplantation, Fond. IRCCS INT, Milan, Italy; II Surgery Division, AO, Italy; Department of Digestive and General Surgery, AO Riuniti, Ancona, Italy.

5/02/08

Reference
TM De Feo, M Colledan, E. Andorno, and others. Results of a 10-year multicenter experience in split-liver transplantation in an Italian transplant program. 43rd Annual Meeting of the European Association for the Study of the Liver (EASL 2008). Milan, Italy. April 23-27, 2008.