Split liver transplantation: The Mount Sinai Experience

UVA P; RODRIGUEZ-LAIZ G; GONDOLESI G; DEL RIO MARTIN J; STURDEVANT M; SCHIANO T; SCHNEIDER B; EMRE S

San Francisco

Congreso; American Transplant Congress; 2007

American Society of Transplantation

Objective: To evaluate our results with Split Liver Tx. Methods: Retrospective review of a prospectively collected database. Results: Between 2/1994 and 6/2006, 72 livers create 144 allografts, 26 were shared and 4 imported. Splitting was ex-situ (ESSL) in 58 and in-situ (ISSL) in 64 cases (67 left lateral segments (LLS), 48 right trisegments (RTS), 5 left lobes and 2 right lobes). Pediatrics (n=78): Extra hepatic biliary atresia (41%), acute liver failure (20.5%) and metabolic liver disease (20.5%) were the leading indications. 36 ESSL and 42 ISSL. 66 received a LLS. Seven patients required portal vein and 9 patients hepatic artery reconstruction. 19.2% were reoperated early posttransplant; most of them in our early experience. Biliary complications developed in 7.7%, portal vein thrombosis (PVT) in 3.8% and hepatic artery thrombosis (HAT) in 2.6%. Primary graft non-function (PNF) was seen in 6.4%. The 3-month retransplant rate was 7.7% (6 patients). The 1 and 5-year graft survival rate was 86% and 78% whereas the 1 and 5-year patient survival rate was 92% and 85%. UNOS Status 1, total ischemia time (TIT) over 14 hours and need for reoperations were strong predictors of graft loss on uni and multivariate analysis. Adults (n=44): Most common primary diagnosis was HCV in 23 patients (52.3%). HCC was present in 34.1%. 23 ESSL and 21 ISSL. Forty-one received a RTS. Mean graft / recipient weight ratio was 1.5%. Portal vein and hepatic artery reconstruction was required in 3 (6.8%) cases each. Reoperation rate was 29.5%, biliary complication rate was 15.9%, HAT 4.5% and PNF 6.8%. The 3-month retransplant rate was 6.8%. The 1 and 5-year graft survival rate was 75% and 53%. 1 and 5-year patient survival rate was 82% and 59%. Predictors of graft loss were Status 1, serum creatinine =1.5 mg/dL, HCV infection and need for reoperation. 12% of HCV patients without perioperative mortality died of recurrent HCV in less than 2 years. In-situ vs Ex-situ: Ex-situ grafts had more TIT and had a trend to a worst graft survival (but not statistically signi* cant) Conclusions: Split liver transplantation is a valuable technique to increase number of grafts. With increasing experience it is possible to decrease number of split related complications and improve outcomes. ISSL split is not superior ESSL in terms of PNF and split related complications although there is a trend for a favorable overall outcome with ISSL.