Split liver transplantation. Academic Article uri icon

Overview

MeSH

  • Adult
  • Bile Ducts
  • Cadaver
  • Child
  • Hepatic Veins
  • Humans
  • Liver
  • Portal Vein
  • Tissue Donors

MeSH Major

  • Hepatectomy
  • Liver Transplantation
  • Tissue and Organ Harvesting

abstract

  • Seventy-five thousand Americans develop organ failure each year. Fifteen percent of those on the list for transplantation die while waiting. Several possible mechanisms to expand the organ pool are being pursued including the use of extended criteria donors, living donation, and split deceased donor transplants. Cadaveric organ splitting results from improved understanding of the surgical anatomy of the liver derived from Couinaud. Early efforts focused on reduced-liver transplantation (RLT) reported by both Bismuth and Broelsch in the mid-1980s. These techniques were soon modified to create both a left lateral segment graft appropriate for a pediatric recipient and a right trisegment for an appropriately sized adult. Techniques of split liver transplantation (SLT) were also modified to create living donor liver transplantation. Pichlmayr and Bismuth reported successful split liver transplantation in 1989 and Emond reported a larger series of nine split procedures in 1990. Broelsch and Busuttil described a technical modification in which the split was performed in situ at the donor institution with surgical division completed in the heart beating cadaveric donor. In situ splitting reduces cold ischemia, simplifies identification of biliary and vascular structures, and reduces reperfusion hemorrhage. However, in situ splits require specialized skills, prolonged operating room time, and increased logistical coordination at the donor institution. At UCLA over 120 in situ splits have been performed and this technique is the default when an optimal donor is available. Split liver transplantation now accounts for 10% of adult transplantations at UCLA and 40% of pediatric transplantations.

publication date

  • March 2006

has subject area

  • Adult
  • Bile Ducts
  • Cadaver
  • Child
  • Hepatectomy
  • Hepatic Veins
  • Humans
  • Liver
  • Liver Transplantation
  • Portal Vein
  • Tissue Donors
  • Tissue and Organ Harvesting

Research

keywords

  • Journal Article

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1016/j.transproceed.2005.12.064

PubMed ID

  • 16549186

Additional Document Info

start page

  • 602

end page

  • 603

volume

  • 38

number

  • 2